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[Treatment] Newbie and a question or two
#1
Question 
Hi Guys (and Gals),

I was diagnosed about 6 weeks ago with AHI >32/hr, which was a real shock to the system as I had none of the 'regular' screening symptoms (overweight, tired, falling asleep, high blood pressure etc). Even an ENT specialist and GP did not think I had sleep apnea! The test showed otherwise, and after a short period of disbelief (and cynicism about dodgy results and the vested interests of the test/machine provider - seemed a bit like a rehearsed story-line) I accepted that treatment was necessary.
I rented a Resmed A10 and tried full face, nasal mask and pillows, finally deciding that the pillows are best for me. No issues in using the machine once the mask style was decided. I have now purchased an A10 and am currently (last week or so) receiving good results of between 1 and 3 AHI.

I do however feel that I am more tired in the late afternoon than I ever was and can't at this stage report that I am feeling 'super better' but my sleep is more consistent and seems more restful. Not making as many visits to the loo at night and not waking up followed by long periods of tossing and turning before falling back asleep. Thanks to finding this forum I am also not stressed about this as it seems it can only get better.

I have downloaded my data into both Sleepyhead and ResScan and am trying to make some sense of the results. I have the pressure set auto 4-20 and my results are Median 6.1, 95th Percentile 7.9, Max 9.5 and average AHI 3.3 (45 days)

My question is should I be increasing the lower pressure to the Median (6.1) and will this reduce my AHI?

Great to have such a forum as this to help cut through the lack of reliable information from our provider/suppliers. Thanks for all your efforts.




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#2
Congratulations on starting treatment! 4-20 is wide open. I'm surprised you are ok with 4! I find it too light of a push and I feel starved for air. If your max after 45 days is only 9.5, and your 95th percentile is 8, then lower your machine max to 10 or 10.4. I think you could increase your machine minimum to 6 or 6.4. The most important thing is to be comfortable with the air pushing at you.

AHI of 3.3 is very good btw. So well done on your treatment so far!!
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#3
Thanks trailrider. I have taken a closer look at the Max Pressure (daily rather than summary) and the highest is 13.8.

Would you suggest an upper limit of say 16, or because the machine is auto just leave it where it is.

I will increase the lower pressure up to your suggestion over a few weeks slowly. I find a lower of 4 really good because it requires no effort, particularly on exhale. I don't even know the unit is there once it 'matches' my breathing rhythm!

I have a problem in that I don't really trust advice from the provider/supplier so any advice from the forum is most welcome.

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#4
Welcome iwlong,
I personally like a narrow range. Yes, you should raise your upper limit to 15 or 16.

It's good that the lower limit doesn't bother you, most people feel as if they are not getting enough air set on 4. The reason that I would suggest raising the lower limit is because it takes the APAP longer (when set on 4) to reach the pressure needed to clear an apnea you might be having. Let's say it needs to go up to 12 or so to do its job, then will fall back down to 4. So it's too far of a climb and the up and down of the pressure could cause sleep disturbances in some.

My reconmendation based on what you have said would be to set your pressure range to 7 - 16, then watch your charts for a couple weeks or more before making any more changes.

And I noticed you mentioned you liked a low setting of 4 because it's easier to breath out. There is an EPR setting on your machine that you can set, either 1,2 or 3.
I suggest a setting of 2. This lowers the pressure when exhaling and is only a comfort feature.

Let us know if you make changes and if your AHI drops further.
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#5
Hi iwlong,
WELCOME! to the forum.!
First of all, what OpalRose said.
You have a great attitude towards your CPAP therapy and that goes a long way.
Hang in there for more responses to your post and much success to you with your CPAP therapy.
trish6hundred
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#6
Thanks again guys,

Altered pressures to those suggested and will keep you informed aafter a week or two.

Another query - the manual suggests replacing air filter every 6 months. Is the Airsense 10 filter the same as the S9. A couple of EBay suppliers suggest they are.

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#7
(06-12-2015, 01:20 AM)iwlong Wrote: Thanks again guys,

Altered pressures to those suggested and will keep you informed aafter a week or two.

Another query - the manual suggests replacing air filter every 6 months. Is the Airsense 10 filter the same as the S9. A couple of EBay suppliers suggest they are.


iwlong,
You can check the supplier list (top of page) and look for filters. They usually have
them listed under machine type.
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#8
Ohmy 
Hi again,

Now been 18 days on the suggested new settings of 7-16 and on average there is an improvement but I am finding myself becoming frustrated. I am finding that there is a few days when I am getting 1 or 2 AHI and then a couple of nights when it will go a 5, 6 or even an occasional 8. Having said that the average is 2.8.

The ratio of CA to OA is about 10:1, the reverse of my sleep test.

I am struggling with mouth leaks and when I do a toilet run at say around 6am, and then return to sleep there is a major cluster of CA's in the 1 - 2 hour period before I get up.

I look at the graphs and stuff in both Sleepyhead and ResScan and they show me the events but I don't know what to make of what I see.

I am now finding in the past few days that I am having trouble getting to sleep, OK once I am asleep, but tossing and turning for ages.

Going to GP tomorrow and hope to be referred to a doctor who may be able to read the graphs and advise me. My sleep technician seems useless.
Any advice would be great as I am starting to think it may be easier just to pull the mask off, but I wont let that wont happen - I'm too stubborn.

Don't wish to be negative, things seemed to be going so well.

Any advice would be most welcome

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#9
I think you have to have a few more posts under your belt to post graphs. It would be good when you are able to post a screenshot of events, pressure, flow chart and left side bar.

In the meantime, could you give us a breakdown of your apnea events; hypopneas, obstructed, clear airways, etc.

The CA clusters right before you wake up are typical and should go away with continued treatment.

Also, you need to try to get the leaks under control. If you are mouth breathing, try a chin strap. If it's your mask, try adjusting the straps, or try a size up in nasal pillow.



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#10
Like all above suggestions, but I would check the median pressure again. If median was still below 8.5 I would drop the minimum pressure to 6 vice 7, and EPR to 1 vice 2, to see if this will reduce the CA portion of my AHI score.

If I were now getting a median above 8.5 I would decrease the EPR at least 1, but better 2 points below current setting, even if that meant changing EPR to 0. The same effect on CA is contemplated.

QAL
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
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