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Sleepyhead Results
#1
Ok. So original setting was 4-15 which seemed a bit open, after I saw the doc for the 30 day visit, he agreed that upping the lower setting to 7, was fine, which I did. (Now I get to wait a whole year before my next appointment. Gotta love "modern" medicine. That's why this place is great.) So I upped the lower setting to 7.6, and here's a summary, as well as Thursday night's results.
[Image: SleepyHeadSummary2-22-13.jpg]
[Image: SleepyheadDetail2-22-13.jpg]
I did up it to 8.2 last night , but well only a night, and not much difference to report.

My average AHI has been around 2 for the past 3 weeks, and yes I'm feeling better. (In fact, the first night with the CPAP I felt better immediately. There's a whole story which brought me back from a hiatus from CPAP, which I'll share in another thread in the future.).

Special thanks to the patience offered to me by Super Sleeper (who is also a Super person) and to PaulaO2 - with this thread on attachments.

Anyway, if there's anything additional I need to post, or if folks have suggestions, I'd be grateful to hear them.
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#2
Your AHI is dominated by CAs. More pressure will not help those, will make AHI higher. Only seven days of data at 7.6 - 15, but if it were me, I would go back to 7 - 15 setting. See if that decreases CA events a little. Let it stay there (7 - 15) for a month or more. After a while you might see that the CA events start decreasing on thier own as body gets used to the pressure (i.e. sometimes pressure causes hyperventilation, so brain makes you stop breathing periodically until body gets used to pressure and automatically slows respiration evenly). If, after a month or so, CAs come way down, but OAs and Hs still more than you like, then you may be able to start increasing minimum pressure at that point, but if AHI stays mainly CAs with only a couple OAs and Hs, then you may want to actually look at decreasing max pressure. So far, if posted night is typical night, CAs seem to be the only concern. Minor concern at that, because any AHI under 5 is good as long as you feel good and are getting restfull sleep.

Sleep-well
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#3
the leak graph shows leak spikes in some periods and none in other periods
indicate variable leaks, most likely mouth leaks
a chinstrap helps keeps mouth closed and minimize mouth leaks








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#4
Zonk, you should have seen my leak profile before I used a chinstrap. Lol.
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#5
I agree with zonk. Those spikes are likely caused by mouth leaks. Do you ever wake up with air hissing out of your mouth?

A chinstrap may be necessary, hopefully as only a temporary measure.
Sleepster
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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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#6
I have a chinstrap. Use the PapCap, but sometimes it comes off during the night. But yes, that what must have happened during the night posted.
(02-23-2013, 01:27 PM)jgjones1972 Wrote: Your AHI is dominated by CAs. More pressure will not help those, will make AHI higher. Only seven days of data at 7.6 - 15, but if it were me, I would go back to 7 - 15 setting. See if that decreases CA events a little. Let it stay there (7 - 15) for a month or more.
Thanks for the suggestion. Makes sense. Wonder if I should reduce the max, but I'll reset to 7-15 for now.

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#7
You don't want to make too many changes at once or you won't know which one did what. Monitor for two weeks and then re-evaluate.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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#8
(02-23-2013, 08:34 PM)GaryG Wrote:
(02-23-2013, 01:27 PM)jgjones1972 Wrote: Your AHI is dominated by CAs. More pressure will not help those, will make AHI higher. Only seven days of data at 7.6 - 15, but if it were me, I would go back to 7 - 15 setting. See if that decreases CA events a little. Let it stay there (7 - 15) for a month or more.
Thanks for the suggestion. Makes sense. Wonder if I should reduce the max, but I'll reset to 7-15 for now.

Hi GaryG,

Yes, higher pressures are often associated with higher incidence of CA events, so it makes good sense to be on the look-out for that. On the other hand, for the night shown, it does not look like your CA events occur more frequently when the pressure is high.

The pressure went as high as 14.2, and one CA ocurred up near there, and the pressure went as low as 9.0 toward the end of the night, and some CAs occurred near there. The pressure spent most of its time in the middle around 10 or 11, and that was where most of the CA events occured. (If the frequency of CA events is not influenced by the pressure, then most CA events would occur wherever the pressure happened to spend most of its time.)

You have about 50 days of data to look at, all with 15 cmH2O as the Max Pressure. If a detailed review of all the days showed the CA events were occurring more frequently when the pressure was highest, then, as jgjones1972 has pointed out, you may want to consider trading off OAs versus CAs by lowering the Max Pressure. But, on the other hand, while lowering the Max Pressure would likely worsen the number of OA events, the data for the one night posted does not seem to show that lowering the Max pressure would influence the amount of CAs. You would have to look in detail at the data for many more nights to see whether decreasing the Max Pressure would be likely to help or to hurt the AHI.

When looking at the data, however, keep this in mind: More important than AHI is how long do the apneas last (or how bad are the O2 desaturations?). If occasionally some of the OAs are very long (>40 seconds) but the CAs are always short (<20 seconds), then of course you might not want to trade off more OAs for fewer CAs.

Regarding the Minimum Pressure, lowering the Min Pressure from 7.6 to 7.0 is not going to make any difference if the pressure never spends any time at the minimum.

Actually, I think it is not clear whether raising or lowering the Min Pressure would neccessarily help or hurt. Some studies have reported that, for about two thirds of the patients experiencing CAs, the frequency of CAs (the CA Index) lowers as patients get used to PAP therapy. Would lowering the Min Pressure to 7 make it harder to get used to the treatment, because your pressure would be varying over a greater range? Maybe RAISING the Min Pressure might help lower your CAI, because it would give you a more consistent pressure?

We don't really know what is the best approach for adjusting the Min Pressure in order to influence CAI. I think I do best when my Min Pressure is set near my average pressure. For a time I kept my Min Pressure as low as I could stand it, to see if my CAI would get lower, but I found that my CAs were occurring just as often when my pressure was low as when it was high. Seemed to make no difference in my case. But, in my case, during my two overnight sleep studies, my baseline periods showed Central Apneas were occurring even without CPAP.

One thing that quite a few patients have observed is their CAI gets better when they turn off EPR. Now that you are used to the therapy, maybe you could try turning off EPR for the next month and see if it helps in your case.

Take care,
--- Vaughn





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. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#9
Vaughn, Thanks. - Lots of information in your post. If I can summarize (with a few questions in blue and comments in green)
1. Look to see at what pressure CA events are occurring. If more CA’s at higher pressure – may want to lower the max. (which may increase OAs) I will check my history. Thanks
2. Look to reduce apneas with longest duration. With Resscan, the duration is visible. How do I check duration with sleepyhead?
3. Review O2 desaturations How?
4. Personal observation – does better when min pressure around average pressure Interesting
5. CAs may lower over time anyway. Interesting
6. Consider turning off EPR Will consider. Thanks


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#10
A few statistics comparing the time my setting was (4-15) vs (7 or 7.6 to 15)

In either range, CA's make up 61% of my total Apenas. (CA+OA+UA+H). Also, there was no correlation between pressure and when the CA's occur. However, there is a general observation that my readings are generally clear of CA's early in the night, and more prevalent thru the night and before getting up.

Average pressure: (4-15) 8.4, (7-15) 9.8
95% pressure: (4-15) 10.5 (7-15) 11.7
So increasing the minimum does impact average and 95% pressure.
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