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Rough night!
#1
Hi All,

Still new to all of this. I have been averaging around 5 AHI for the last month. Last night it was 12.9 and I captured a couple of snippets from the sleepyhead software to review. I'm not to familiar with how to interpret it so I thought I'd put it up on the boards for input (any and all is appreciated!). It looks like I am having alot of OA's in these strips. Wonder if I need to up my pressure (it is 8-13 now).

Thanks very much in advance Thanks

Monte



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#2
Welcome

Anything above a 5 for AHI (nightly) is not good.
If you can stay below 5 (most nights) your average should stay below 5.

I see one graph where you are doing 43 AHI. Those OA's in clusters like that are killers. Seriously NOT good.
If I was your doc I would set your low pressure at 13 and high at 18-20...
BUT, first you need to adapt to the therapy so you can get toughened up to handle higher pressures.

I am not a Dr so be sure to work closely with your primary physician on this. Just in case they forget you exist.
If all else post your experiences here and let the other members help you out.

Cheers and hang in there!

Sleep-well

"With ordinary talent and extraordinary perseverance, all things are attainable." - Thomas Foxwell Buxton

Cool
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#3
(07-20-2013, 11:05 AM)Shastzi Wrote: Welcome

Anything above a 5 for AHI (nightly) is not good.
If you can stay below 5 (most nights) your average should stay below 5.

I see one graph where you are doing 43 AHI. Those OA's in clusters like that are killers. Seriously NOT good.
If I was your doc I would set your low pressure at 13 and high at 18-20...
BUT, first you need to adapt to the therapy so you can get toughened up to handle higher pressures.

I am not a Dr so be sure to work closely with your primary physician on this. Just in case they forget you exist.
If all else post your experiences here and let the other members help you out.

Cheers and hang in there!

Sleep-well


Thanks Shastzi. They want another sleep study but my insurance won't pay. I have a clinicians manual so I can up the pressure myself.

Does anyone know how accurate the machine (Remstar auto a flex - system one) is when differentiating between obstructive apneas and central apneas? I understand that is what the belts are for in sleep studies. I have heard that higher pressures can cause central apneas. I have some hesitation in changing pressure because I don't know if these clusters of apneas are truly obstructive or central.??? Dont-know

Any input on this?

Thanks!

Monte



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#4
(07-20-2013, 12:35 PM)montehotbike12 Wrote: Does anyone know how accurate the machine (Remstar auto a flex - system one) is when differentiating between obstructive apneas and central apneas?
Detection accuracy of obstructed airway versus clear airway apneas
http://www.healthcare.philips.com/pk_en/...apneas.wpd

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#5
(07-20-2013, 10:29 AM)montehotbike12 Wrote: Hi All,

Still new to all of this. I have been averaging around 5 AHI for the last month. Last night it was 12.9 and I captured a couple of snippets from the sleepyhead software to review. I'm not to familiar with how to interpret it so I thought I'd put it up on the boards for input (any and all is appreciated!). It looks like I am having alot of OA's in these strips. Wonder if I need to up my pressure (it is 8-13 now).

Thanks very much in advance Thanks

Monte

You don't show leak rate in these samples. If your mask leaks that can cause major problems.
If have no leaks I would raise the upper limit of pressure incrementally until you do not see plateaus at the upper limit.
Than consider raising the lower limit a bit.
You and I need to learn the terms in all the different parameters displayed by Sleephead Software so we can make sense out of our reports.
I firmly believe I care more about my results and health than any doctor or DME.

Bob
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#6
(07-21-2013, 02:19 PM)bwexler Wrote:
(07-20-2013, 10:29 AM)montehotbike12 Wrote: Hi All,

Still new to all of this. I have been averaging around 5 AHI for the last month. Last night it was 12.9 and I captured a couple of snippets from the sleepyhead software to review. I'm not to familiar with how to interpret it so I thought I'd put it up on the boards for input (any and all is appreciated!). It looks like I am having alot of OA's in these strips. Wonder if I need to up my pressure (it is 8-13 now).

Thanks very much in advance Thanks

Monte

You don't show leak rate in these samples. If your mask leaks that can cause major problems.
If have no leaks I would raise the upper limit of pressure incrementally until you do not see plateaus at the upper limit.
Than consider raising the lower limit a bit.
You and I need to learn the terms in all the different parameters displayed by Sleephead Software so we can make sense out of our reports.
I firmly believe I care more about my results and health than any doctor or DME.

Bob


Thanks for the reply. Here is an expanded view to include leak rate.




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#7
If this a typical reports, you need to show the reports to your sleep physician
Leak rates showing are minimal for full face mask "total leak rate"
I believe, you can change some setting in SleepyHead to show unintentional leak vs total leak

I have no idea if "system one resistance" settings makes any difference, reistance setting for Respironcis full face masks "X1", but from what have read ... resistance setting "0" for non-Respironcis masks
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#8
Just wanted to thank everyone for their input and help. Last PM was MUCH better. After looking at some of my graphs over the past couple of weeks I noticed most of my OA's were in clusters. I wondered if these might be times when I was sleeping on my back so I sewed a tennis ball into the back of a t shirt last PM. AHI was 2.32 last night compared to 12.5 and 8.9 the previous 2 nights (it has never been less than 5 since I started CPAP therapy).

Here is a clip from last PM.



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#9
(07-21-2013, 03:32 PM)montehotbike12 Wrote: Thanks for the reply. Here is an expanded view to include leak rate.
Congratulations on your first AHI below 5. Way to go!

If your leak line is this consistent from night to night, (seems very good on both nights), then it looks like you have that that under control. The upper line is the total leak, including expected leak from the mask. The lower line is the amount you're leaking over expected leak. If the leak line on either of these graphs were mine, I'd be content.

Image A:
[Image: attachment.php?aid=438]

Image B:
[Image: attachment.php?aid=439]

It looks like you have changed your pressure regime from the first night (lowest pressure 8.0 in Image A) to the second night (lowest pressure 9.0 in Image B). I wonder if that might be part of the reason why your AHI is lower. It looks like almost all your obstructives became hypopneas.

Image C:
[Image: attachment.php?aid=437]
In Image C , it looks like as soon as you hit 12.0cm pressure, everything became stable and you didn't have many events. If you took a closer look (30 minute span) at the 4:45 to the end of the night on image C, I suspect you would see relatively consistent breathing. Of course this is only an hour of information, so it helps to look at the entire night graphs you've provided too.

If these were my graphs, I'd try a few more nights on the current regime and see what the numbers look like, since this the first-ever 2.3 AHI, with a pressure line that is fairly flat across the night. It is my understanding the body takes a while to adjust to a new pressure regime.

At some point after a few days, I might consider dialing up my lower pressure setting a notch to see if I could get rid of those hypopneas, since most of my apneas would be obstructive and centrals are minimal.

Of course, I'm not a doctor, so these are merely opinions. Since you seem to be self-titrating, you are in charge of your own therapy. Good luck withe the tennis balls! I hope this has been helpful.

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#10
Dreamdiver

Fantastic analysis! As you suggested I checked some other nights and the leak rate seems low. You are correct!....I changed my pressure from 8 to 9- I will keep it there for a few nights and see how it goes...then as you suggested I will bump it up again to see if the hypopneas improve.

I looked at the time from 4:45 AM until I woke up (Image C) and again you were correct....breathing pattern was great.

Thanks again for your help friend!

Monte
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