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No events with at-home titration.Why does pressure increase?
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Terry Offline

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Post: #11
RE: No events with at-home titration.Why does pressure increase?
(04-22-2015 04:11 PM)jdip Wrote:  
(04-22-2015 03:24 PM)Terry Wrote:  You definitely have "something". The machine won't go from 4->10 for no reason.

If you want, you can select a section of the flow rate graph where the pressure had gone to 10 and see what the waveform looked like.

The flow rate waveform definitely changes when there are spikes in the pressure. I also had a lot of spikes in pulse rate all over the place. I'm anxious to see what my doctor will say. Thank you for sharing your thoughts.

Enjoy! I see happy sleeping and wide-awake days in your future. 8-)



Terry
04-22-2015 06:13 PM
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jdip Offline

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Post: #12
RE: No events with at-home titration.Why does pressure increase?
(04-22-2015 06:13 PM)Terry Wrote:  Enjoy! I see happy sleeping and wide-awake days in your future. 8-)



Terry

Thanks for the positive vibes, Terry. I hope you're right.
04-22-2015 07:46 PM
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archangle Offline
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Post: #13
RE: No events with at-home titration.Why does pressure increase?
(04-22-2015 06:10 PM)jdip Wrote:  I did tell SleepyHead to save a backup of the data on my hard drive for future reference. I don't know which files are required for you to view, so I just zipped everything. It's only one night, in two segments (first segment was me in bed unable to sleep, disconnecting to go to the washroom, then started again on the second segment). Let me know if the data works for you. From what I can see, the snores were minimal (I'm not a big snorer, but it happens sometimes) and there weren't any major leaks.

Thanks. Worked well. It's got your name in the file if you care to delete it now.

I don't see anything all that interesting in the data. My best guess is it upped your pressure due to flow limitations. Your flow rate waveforms don't look that bad, but they are a bit flat topped, and your flow limitations seem to go up before it raises pressure.

The machine thinks you needed CPAP. I'm not sure how conclusive that is. It might be worth a trial period, but I don't know how insurance will feel about that. Just buying a good auto CPAP would be cheaper than a sleep study, but logic doesn't apply to insurance.

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
04-22-2015 08:23 PM
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jdip Offline

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Post: #14
RE: No events with at-home titration.Why does pressure increase?
(04-22-2015 08:23 PM)archangle Wrote:  Thanks. Worked well. It's got your name in the file if you care to delete it now.

I don't see anything all that interesting in the data. My best guess is it upped your pressure due to flow limitations. Your flow rate waveforms don't look that bad, but they are a bit flat topped, and your flow limitations seem to go up before it raises pressure.

The machine thinks you needed CPAP. I'm not sure how conclusive that is. It might be worth a trial period, but I don't know how insurance will feel about that. Just buying a good auto CPAP would be cheaper than a sleep study, but logic doesn't apply to insurance.

Oops, didn't realize my name would be on there. Looks like I can't edit my post after a certain amount of time... Will ask a mod to remove it.

Thanks for giving me your interpretation on my data. I actually don't have insurance at the moment so I would be paying out of pocket either way. I would like to do a trial to see if it helps, but I'll wait and see what my doctor has to say first.
(This post was last modified: 04-22-2015 08:50 PM by jdip.)
04-22-2015 08:50 PM
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archangle Offline
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Post: #15
RE: No events with at-home titration.Why does pressure increase?
Can you delete it from filedropper?

The SD card has no personal data, but if you put your name into SleepyHead, it's in the directory you downloaded. Unlikely anyone would make the links, and probably not a big deal, but...

Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
04-22-2015 08:54 PM
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TyroneShoes Offline

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Post: #16
RE: No events with at-home titration.Why does pressure increase?
If you are waiting for a time for them to act, the good news is that if you still have the autoset, you can do some titration on your own to get an idea what your pressure range should be. I would start at ~7-10 and see if pressure raises significantly. If not, ~7 may be your ideal bottom limit pressure, and if the machine does not top out at 10, that may be your best top limit for now. If it does top out, you may want to raise the top limit, and if it consistently raises higher than 7-9, you may want to up the low limit.

The idea of getting the low limit high enough is that this will mean that if there are events that cause pressure to raise, it is already part-way there and it will not take 3 events before it raises to a level that works to prevent successive events.

The idea of getting the high limit low enough is that high pressure is uncomfortable, may wake you, aggravates mask leaks, and may even cause central events. I think, generally speaking, it only needs to be raised if it is topping out.

So narrowing the range is a goal to strive for. Often they first send you home at 5-20 so that a pressure that works for you in APAP becomes apparent (they are using it to titrate you, basically). So they are in reality striving for the same goal.

You can fudge those numbers up and down to see how things go, but remember that a single night is not enough data to really justify a change in pressure, because there is a lot of variability night to night. Averaging 1.5, I may have a couple of 0.8's followed by a 2.2, for instance. Once you have your machine, you may want to wait a couple weeks between tweaks just to get valid info supporting a change.

As well as seeing if the pressure raises, chart your AHI in SleepyHead, and see if you can find a range where AHI is lowest.

These are processes usually performed by folks after they have a PSG and get their own machine, but during your waiting period I think there is likely no harm in trying to start that process. The sleep doc may even take that into account along with the PSG in his diagnosis, or in his recommendation/prescription for type of machine. APAP may not be enough; you may need bi-level, ASV, or some other more sophisticated machine depending on what is found.

But these are common procedures many of us undertake. We find that if you simply leave it all up to the sleep doc, visits every 3 months followed by pressure change recommendations will take many months longer than understanding the physics, parsing the data yourself, and tweaking on your own every couple of weeks.

For instance, after my PSG my sleep doc said "brick it to straight 8". I did for 30 days, and my AHI was about 3. It would still be there if I had not tweaked to an eventual 10-14 four months ago, and ever since, my AHI has been half that.

So if my doc had his way, I would still be getting strangled in my sleep 24 times a night instead of 12 times a night. It seems that lower is better.
04-22-2015 08:56 PM
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jdip Offline

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Post: #17
RE: No events with at-home titration.Why does pressure increase?
(04-22-2015 08:54 PM)archangle Wrote:  Can you delete it from filedropper?

The SD card has no personal data, but if you put your name into SleepyHead, it's in the directory you downloaded. Unlikely anyone would make the links, and probably not a big deal, but...

Nope, can't delete it from filedropper because I didn't use an account to upload that. I PMed a mod requesting them to edit out the link.

(04-22-2015 08:56 PM)TyroneShoes Wrote:  If you are waiting for a time for them to act, the good news is that if you still have the autoset, you can do some titration on your own to get an idea what your pressure range should be. I would start at ~7-10 and see if pressure raises significantly. If not, ~7 may be your ideal bottom limit pressure, and if the machine does not top out at 10, that may be your best top limit for now. If it does top out, you may want to raise the top limit, and if it consistently raises higher than 7-9, you may want to up the low limit.

The idea of getting the low limit high enough is that this will mean that if there are events that cause pressure to raise, it is already part-way there and it will not take 3 events before it raises to a level that works to prevent successive events.

The idea of getting the high limit low enough is that high pressure is uncomfortable, may wake you, aggravates mask leaks, and may even cause central events. I think, generally speaking, it only needs to be raised if it is topping out.

So narrowing the range is a goal to strive for. Often they first send you home at 5-20 so that a pressure that works for you in APAP becomes apparent (they are using it to titrate you, basically). So they are in reality striving for the same goal.

You can fudge those numbers up and down to see how things go, but remember that a single night is not enough data to really justify a change in pressure, because there is a lot of variability night to night. Averaging 1.5, I may have a couple of 0.8's followed by a 2.2, for instance. Once you have your machine, you may want to wait a couple weeks between tweaks just to get valid info supporting a change.

As well as seeing if the pressure raises, chart your AHI in SleepyHead, and see if you can find a range where AHI is lowest.

These are processes usually performed by folks after they have a PSG and get their own machine, but during your waiting period I think there is likely no harm in trying to start that process. The sleep doc may even take that into account along with the PSG in his diagnosis, or in his recommendation/prescription for type of machine. APAP may not be enough; you may need bi-level, ASV, or some other more sophisticated machine depending on what is found.

But these are common procedures many of us undertake. We find that if you simply leave it all up to the sleep doc, visits every 3 months followed by pressure change recommendations will take many months longer than understanding the physics, parsing the data yourself, and tweaking on your own every couple of weeks.

For instance, after my PSG my sleep doc said "brick it to straight 8". I did for 30 days, and my AHI was about 3. It would still be there if I had not tweaked to an eventual 10-14 four months ago, and ever since, my AHI has been half that.

So if my doc had his way, I would still be getting strangled in my sleep 24 times a night instead of 12 times a night. It seems that lower is better.

Thank you, this is really good advice and makes a lot of sense. I'm a tinkerer so I definitely would have done this, but unfortunately I only had the machine for the single night. I agree that a single night is not much of a sample size, especially when I'm not used to it/sleep badly that night.

It's great that you were able to get your AHI down like that! Do you think you can get it even lower with higher pressure? I understand that at higher pressures leaks and aerophagia become an issue.
04-22-2015 09:07 PM
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DeepBreathing Offline
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Post: #18
RE: No events with at-home titration.Why does pressure increase?
(04-22-2015 08:50 PM)jdip Wrote:  Oops, didn't realize my name would be on there. Looks like I can't edit my post after a certain amount of time... Will ask a mod to remove it.

Jdip, I've removed the link from your post.

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04-22-2015 09:49 PM
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jdip Offline

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Post: #19
RE: No events with at-home titration.Why does pressure increase?
(04-22-2015 09:49 PM)DeepBreathing Wrote:  Jdip, I've removed the link from your post.

Thank you; much appreciated!
04-22-2015 09:51 PM
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OpalRose Offline

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Post: #20
RE: No events with at-home titration.Why does pressure increase?
I have similar issue with pressure rising. When looking at data, all I can see is that is rises when there are flow limitations and snoring flagged, although my husband doesn't hear me snore since on CPAP. Thinking-about

I also notice there are no apnea events during the time the pressure rises. But there's no way of knowing if it took care of an apnea before it happened.

I've tinkered with pressure settings by raising up from 8 to 9, but Flow Limitations are still high, but with lower AHI. If I move pressure back to start at 8, I end up with higher AHI. I guess it's a balancing act that I've haven't quite figured out yet!

OpalRose
04-23-2015 07:32 AM
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