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New to Apnea but need guidance
#1
New to Apnea but need guidance
Hi everyone,

I'm sure this sort of thing has been asked before, but it's all new to me, so here goes....I'll try to keep it as concise as possible!

Sleep study Results:

AHI of 15 (right on cusp of light to moderate).  Dr said most likely moderate since the at home machines are less accurate.
Mean O2 sat. = 93%
Lowest O2 sat. = 80%
O2 sat. was <90% for 4 minutes.
I sleep on my back (supine position) for only 5% of the time.
20% of the events are obstructive apneas.
80% of the events are hypopneas.
I snore.

Prescription:

Auto CPAP with humidifier and heated tubing.
Pressure settings of 5cm to 15 cm H2O

First things first, I'm in Canada, went to a private clinic for the test.  Saw the Dr (who is not a private Dr. but visits the private clinics) who explained everything.
The clinic gave me a quote for a machine+mask ($2075).  I left without being given my prescription, did some research, found the machine+mask+heated tubing+regular tubing+filter+wipes for a grand total of $949.  I had to argue to get my prescription from the clinic.  Eventually got the prescription and bough the machine online.

Treatment/Results:

I've used the machine now for 5 nights so far.
During those 5 nights, my AHIs so far are 6.7, 5.2, 4.5, 4.9, 7.3
AFlex is on (I think the setting is 3)
90% Pressure for the 5 days = 9.7, 8.6, 9.6, 8.6, 9.3 (average = 9.2)
Hours of usage = 9:04, 7:07, 7:36, 6:13, 7:34
Mask fit: 100% 

Last night my AHI was worse than the 4 previous nights at 7.3.  It was also the night that my nose kept itching and every time I went to scratch it I broke the seal which caused the machine to blow like a bloody hurricane in my face and had a hard time re-sealing.  So my sleep was pretty broken last night.



Questions/Thoughts:

I installed Sleepyhead on my PC but it's almost too much info!  I'm not sure what I'm looking at really (and I am an analytical chemist, so I'm accustomed to data!).  Since I bought the machine online instead of going through the private clinic, I don't have a Dr for followup yet.  I'm on a waiting list at the hospital for followup care (this could take 1 to 3 months), so in the meantime, I'm on my own for making tweaks to my treatment.  There's obviously an improvement over when I was untreated, but I think there's room for improvement.

Is 5 nights worth of data enough to make any conclusions/decisions concerning how my treatment is going?

I've read that your min pressure should be ~2 cm lower than your 90% pressure.  Since my 90% pressure is ~9cm, should I go ahead and update the min pressure to 7?

Is there a rule of thumb for the max pressure based on 90% pressure value?

What is the Flex value?

I seem to be getting a stuffy nose throughout the night.  Is this due to too much humidification or not enough?

I guess that's it for now! 



Machine:  Philips Respironics Dreamstation Auto w/humidifier and heated tube
Mask:  Philips Respironics Amara View

Thanks everyone!
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#2
RE: New to Apnea but need guidance
(06-14-2017, 10:20 AM)rorielly Wrote: I've read that your min pressure should be ~2 cm lower than your 90% pressure.  Since my 90% pressure is ~9cm, should I go ahead and update the min pressure to 7? 8 would be better.  PR machines are a bit slow to react.

Is there a rule of thumb for the max pressure based on 90% pressure value?
No

What is the Flex value?
No sure I understand your question.  If you mean: what is it set to, then you've not given enough data.  I think the sleephead display should show what Flex is set to. You should also be able to see the Flex setting by the split in the pressure graph.

I seem to be getting a stuffy nose throughout the night.  Is this due to too much humidification or not enough?
Generally not enough.  But it can go either way.

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#3
RE: New to Apnea but need guidance
Hi rorielly - Welcome
(06-14-2017, 10:20 AM)rorielly Wrote: I installed Sleepyhead on my PC but it's almost too much info!  I'm not sure what I'm looking at really
Here is a link you should read to better explain the data:
Robysue's Beginner's Guide to Sleepyhead

(06-14-2017, 10:20 AM)rorielly Wrote:  I had to argue to get my prescription from the clinic.  Eventually got the prescription and bough the machine online.
You should also get a copy of your Sleep test results for your files.

(06-14-2017, 10:20 AM)rorielly Wrote: I've read that your min pressure should be ~2 cm lower than your 90% pressure.  Since my 90% pressure is ~9cm, should I go ahead and update the min pressure to 7?
Generally that will work for a Resmed unit but the P-R machines are a little slower to respond to OA's and Hypopneas.  They need to be set closer to the 95% number.  I would set it to 9cm.

I hope this helps.

Edit: Thanks to Mongo for pointing out that my original post was incoherent.
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#4
RE: New to Apnea but need guidance
Hi rorielly,
WELCOME! to the forum.!
Good luck to you on your CPAP journey.
trish6hundred
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#5
RE: New to Apnea but need guidance
ok thanks for the info.

I'll update my min pressure tonight and see how things go.  

For the Flex setting, I didn't know what it did.  I just read it has to do with making it easier to exhale.  I guess I'll have to play with the setting.
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#6
RE: New to Apnea but need guidance
You're really doing well for the first week. you're tolerating wearing the mask and able to fall asleep with it on. that's further than a lot of people get. no need to be hasty in adjusting your settings.

I would turn the "opti-start" feature on. this will start the therapy closer to your 90% pressure on its own. no need to manually up the epap.

Flex is a comfort feature. A small amount of pressure relief when exhaling. higher the number, more relief.

Stuffy nose...increase humidity.


Good luck.
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#7
RE: New to Apnea but need guidance
ah ok thanks.  I'll look at turning on opti-start before making any major changes.
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#8
RE: New to Apnea but need guidance
good luck with your therapy.  I believe this link can give you the basics on the flex setting:

http://www.apneaboard.com/forums/Thread-...#pid206250

I do think that you can get a good setting by selecting min pressure at the greater of two values:

Median pressure
or
2 cm below 90% pressure.

Opti-start uses 30 hours of data to select a good start value, so will take longer than most of the forum nozzle-faces can stand.  I gave up on mine and turned it off.  It also didn't pick the pressure very aggressively.

A bit more about your AHI, please - can you tell what portion of your AHI is obstructive (OA), hypopnea (H), and clear airway (CA)?

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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#9
RE: New to Apnea but need guidance
this is a screenshot of my sleepyhead stats.  As you can see, it's mainly hypopneas I have.  sorry, I had to figure out how to post an image.

This is last night (min pressure changed to 8):
[attachment=3585]

This one is from a couple of nights ago when it was set to min of 5 and no leaks.
   
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#10
RE: New to Apnea but need guidance
it turns out optistart was on, so I upped the min pressure to see how that works out.  It went ok, but I still have to tweak the mask fit as it has some small leaks that are annoying and waking me.
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