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[Pressure] New User for three weeks
#1
New User for three weeks
Hi All -

New user to APAP here.  Been using machine for about 3 weeks now.  Sleep study showed untreated AHI of 22.  Prescription was for APAP at 7-10 with CFlex of 3.   Study says CPAP of 7 appeared necessary and sufficient to eliminate most obstructions and O2 saturation above 88%.  The AHI was 1.6 and RDI was 11.1 at this pressure (7).

In looking at Sleepyhead data and charts, I note that the pressure when needed tends to hang out towards the max of the settings.   When I started for the first 2 weeks or so, I was more tired during the day.   That seems to be going away a bit, but I would say I still feel tired.

The only setting I adjusted was reducing Flex from 3 to 2.

Q:  How does the data look?   Q:  Any suggestions?

Thanks!

[attachment=5659] [attachment=5660]
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#2
RE: New User for three weeks
I'd set your minimum pressure to 10cm maximum pressure to 13cm and reduce the Cflex to 2. The increased pressure should help with the obstructive events and reducing the flex may help with the CA events.
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#3
RE: New User for three weeks
(05-02-2018, 04:35 PM)aloha808 Wrote: Hi All -

... The AHI was 1.6 and RDI was 11.1 at this pressure (7).

...

 

Hi, and welcome.  The nice folks here with experience will help you to get better results one way or another.

Per the quoted text above....when was that AHI of 1.6 achieved?  It was much higher in the sample of sleepyhead data you posted above.
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#4
RE: New User for three weeks
Welcome aloha
As walla walla said an increase in min and max pressure is indicated by the number of H. You have already decreased your flex from 3 to 2. I would recommend a slower path and use 8-11 for a week so we can see the difference, then 9 - 12 and finally 11 - 13 as walla walla suggested. This treatment is a life long trip and slow can be beneficial.
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#5
RE: New User for three weeks
(05-02-2018, 04:35 PM)aloha808 Wrote: New user to APAP here.  Been using machine for about 3 weeks now.  Sleep study showed untreated AHI of 22.  Prescription was for APAP at 7-10 with CFlex of 3.   Study says CPAP of 7 appeared necessary and sufficient to eliminate most obstructions and O2 saturation above 88%.  The AHI was 1.6 and RDI was 11.1 at this pressure (7).

In looking at Sleepyhead data and charts, I note that the pressure when needed tends to hang out towards the max of the settings.   When I started for the first 2 weeks or so, I was more tired during the day.   That seems to be going away a bit, but I would say I still feel tired.

The only setting I adjusted was reducing Flex from 3 to 2.

Q:  How does the data look?   Q:  Any suggestions? 

Your setup is not too bad. I would increase the minimum pressure to 8 cm and the maximum to 12 cm based on the one chart you posted. Flex in my opinion is simply a comfort setting on the Respironics machines and I would set it at whatever feels good to you. Probably will not have any significant impact on your therapy. What I look for is periods of time when the pressure is at maximum and during that time you still have OA and H events. They can be prevented with more pressure, so it is an indicator that the max pressure setting is limiting your treatment effectiveness. I then look for periods of time when events occur and the machine is at pressures below average. It makes some sense to increase the minimum to try and prevent these events from happening before the machine has a chance to adjust. Suggest you post a chart again with these increased settings and further smaller refinements may be possible. But all in all it looks like you should get effective treatment for apnea with a CPAP at modest pressure settings.
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#6
RE: New User for three weeks
Your Flow Limitation is a little high which could be causing the CPAP to respond with higher pressure.  The CPAP looks at the flow limitation as one factor to determine if additional pressure is required to try to overcome it.  Using a Flex setting aids in reducing the limitation by providing a little "boost" to your inhale cycle to overcome this limitation.  This keeps the CPAP from thinking that it needs to increase the pressure.  The trick to using EPR or Flex, in your case, is to determine the minimum exhale pressure that you need to prevent OA's and hypopneas then add the Flex value to this number to arrive at the pressure you need to set the CPAP to.  The Flex is a little different than its Resmed counterpart (EPR) but should work close enough.
Crimson Nape
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#7
RE: New User for three weeks
That 1.6 was from an overnight sleep study.   What I was feeling, and then seeing in Sleepyhead, just wasn't jiving with what the overnight stay in a lab was showing.  Thats mainly why I was asking questions, to see if things were ok.
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#8
RE: New User for three weeks
Thanks all -

I did increase it over the weekend, and have been running with a 7 - 12 range.   Last couple of nights felt much better!  I will try setting the low end to an 8 this evening.   I knew in my mind I wanted to kick the high end up, so thanks for that confirmation.   Here is last nights chart with a 7-12 range and flex of 2.
[attachment=5732][attachment=5733]
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#9
RE: New User for three weeks
Your going to have good days and bad days. One day's results really are not an all inclusive picture of your treatment. You need to look at several days to try and spot a base pattern. The same can be said about a sleep study.
Crimson Nape
Apnea Board Moderator
www.ApneaBoard.com
___________________________________
Useful Links -or- When All Else Fails:
The Guide to Understanding OSCAR
OSCAR Chart Organization
Attaching Images and Files on Apnea Board
Apnea Helpful Tips

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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