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Sudden Unexplainable Change
Worry less about REM, and more about getting those OA clusters under control Smile

Let's go ahead and increase pressure to 9.0. and make your ramp start at 6-7 rather than 4.
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Thanks for the suggestion.  This is what I don't understand about CPAP therapy.  Anything under 5 is considered normal and that doesn't even require CPAP treatment if you had achieved that without the CPAP machine, but that means that you've stopped breathing or had a partial obstruction 40 times a night if you sleep for 8 hours!  While it's a dramatic improvement from the 70+ per hour (severe apnea) that I was having (over 600 since I used to need at least 9 hours sleep); I would think 40 times a night would still put some stress on your body and limit the deep restorative sleep that we all need.

Now mine has been 1.7 and last night .7 but do you think there's still room for improvement?  I suppose that changing the setting by 1 cm is safe, but why didn't they give me a pressure of 9 to begin with during the sleep study where they spent a half hour hooking up all these wires and equipment? 

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1.7 and 0.7 are very good.  There is room for improvement, but you're getting closer.  Considering this chart, there is still residual obstruction which should be pretty easy to resolve, but maybe better to go for just a 0.5 cm increase.  That would take you to 8.5 cm.  The hypopnea and OA align with some snores.  The leaks are very good with just some occasional mask slips or adjustments.  Hopefully those are not all arousals to adjust the mask.  You are correct in your post that a full 1-cm increase is probably more than what you need at this point.  This is one of those cases where an auto machine could better address these small changes better than having to use fixed pressure, but your results look very good.

[Image: YCEoJPrHFnMDglEQ7cJtLGxqqGObu09z4KZHA9op...ize_mode=3]
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(03-18-2017, 11:21 PM)scottdooley Wrote: but why didn't they give me a pressure of 9 to begin with during the sleep study where they spent a half hour hooking up all these wires and equipment? 

For me personally, I slept for maybe 4-6 hours for my titrated sleep study. They started me on 4 for an hour, then I woke up before they changed it again... I went to the bathroom, and came back, so maybe that interrupted their protocol of raising pressures. After I fell asleep again, they waited maybe half an hour and raised it to 5.  They let me do an hour on 5, and raised it to 6, after an hour raised it to 7, and not long later it was time to be up for the day.

So my dr decided my best pressure is 5, based on the fact that I had slightly more REM sleep with pressure 5 than pressure 7. But my thought was this - why didn't they try more pressures?  They had all night. And hey, if I had good REM sleep at 7, too, then why not try that as a pressure?

Who knows?  

But that's why I'm glad to have an Auto. It's like my own personal titrating sleep study every night!  :-)
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Hey sleeprider,

Well I did try upping it like you suggest.  I changed it to 8.4 (the next increment was 8.6) and surprisingly I had a worse night of 2.5.  I had had a consecutive week of under 1.7.  Please understand I appreciate your help and your advice to drop the EPR was extremely helpful.  Does that mean that 8 cm is the best pressure or are there other possible factors?  I'm also using a ResMED S+ which measures sleep level and it shows lately that I'm waking up 7-8 times a night.  

The clusters seem to be more focused however here is a link to sleepyhead.



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Sometimes we win, sometimes we lose...I'm not ready to concede this one quite yet. The events are at the very beginning and end of your sleep, and the difference between 1.7 and 2.5 after one trial isn't very compelling for a change of just 0.5 cm. The first cluster of events is just at the end of ramp, and I'd say, increase your minimum ramp pressure to 6, so things don't have to change so fast, but overall things look pretty good compared to a week ago.

You keep some odd hours if this chart is correct. You go to bed at 2:00 PM? That's nap time. Smile
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You need to give it several nights at the settings to get an overall feel for how a change works. Our sleep naturally varies daily based on numerous factors such as how tired you are, if you are sick, how much you ate, are you short of sleep from the previous night, and more.
Please organize your SleeyHead screenshots like this.
I'm an epidemiologist, not a medical provider. 
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Hi Hydrangea, 

When I first heard about the auto CPAP idea it sounded like it was the best idea.  It would change as your pressure needs may change as you move around at night.  I asked my sleep doctor about it and he said that auto is great for people who have not had the sleep study and insurance companies are pushing people to it because sleep studies are expensive.

He explained however with auto it will start low and slowly increase, but during the time it gets to get to that pressure you could already have had 5-6 apneas whereas the fixed pressure recommendation is based on analysis of the whole night.

During my sleep study I did have a hard time falling asleep but I hope they were able to get enough data to recommend the right setting.  I found this article online that explains  in more detail how doctors set the pressure.  I thought you guys might find this interesting if you haven't seen it:

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Foolish me I didn’t change the start pressure setting that you had recommended.  I think I’d get better results with that. 

Since it’s occurring at the beginning and end of sleep is it possible that it's recording when I took the mask off and recording that as sleep apnea?  I never consciously wake up in the middle of the night, but some nights when I have a hard time falling asleep I might get up to get a drink.  I don't turn the machine off I just wait for the Airsense smart sensor to automatically turn it on and off anytime during the night and in the morning at the end of the session.  Sometimes it takes a little while before it detects that it's off but it already has leaked a lot.  Would the machine in this instance falsely record that as an apnea possibly?  Or maybe the sleep apnea event is too long?  Just thought I'd throw that out there. Last night btw I was awake after the pressure got to 8.4 because I wanted to make sure it was correct. That also seems to point to it recording when I was awake unless I happened to fall asleep shortly after it got to 8.4 (I dont recall how long it took me to fall asleep)

One thing I recall about waking up was that I laid in bed awake longer than usual, maybe about a half hour after I awoke, but did not fall asleep.  Can it record sleep apnea while awake or is that just central ai?  The reason I suggest that and it might be only because it's such a short time I've had times where I had the mask on sitting in bed, but never fell asleep and it shows a bunch of sleep apneas but it's only a session of a few minutes. Once I revamp the pressure however it seems to delete the data as my AHI in the morning shows fewer than it showed then.

Things are definitely much better than a week ago, I’m going to give it a couple more days to see.

I do work odd hours of 12:30 to 9, but the time is way off.  I might go to sleep between 12:30 and 1:30 - in the morning not afternoon (latest). I also do not take naps since starting CPAP therapy. My schedule is about to change for the better though on Monday as I got a normal 8:00 am shift now so I hope that will help get my circadian rhythm in sync.  Thanks
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Fixed This Quote: "whereas the fixed pressure recommendation is based on analysis of the one whole night you happened to be in the lab."

And we all know the auto machine only starts at low pressure for as long as we ignore the data the machine is collecting for us. Of course this requires somebody to take an active interest in the patient's welfare, and who better than the patient? Some doctor's have too little knowledge of, and faith in the abilities of their patients.

But it does, sort of, explain the attitude of some sleep doctors.

/end rant
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