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could use some help getting dialed in
#1
could use some help getting dialed in
Hi all, I've been lurking for a while and decided to start posting.  Great forum with a ton of useful information and extra helpful people, thank you to you all. 

I'm a big guy, big neck, always been a big snorer, never wake up feeling rested, my doctors have historically tried to get me to get a sleep study suggesting apnea.  I've recently started taking my health more seriously and even though I'd between insurance and money is tight I thought I'd try out an autopap machine and see if I felt better without having the sleep study.   I ordered the philips autopap, nuance pro and have been fiddling around for a while.  I know I should have a sleep study done at some point and get professional input but this seems better than none.

Overall I don't feel like its made much of a difference in how I feel in the AM, however after about 3-4 days use I noticed a roughly 10 point decline in my average blood pressure which seems too coincidental to be unrelated.  I think I need to dial in the settings and get used to it over the next few weeks and would appreciate any help you all can give me on that.  Here is a few days data from sleepyhead (please assemble link - new member)

imgur.com /a/elFWY

You can tell I'm playing around with the low pressure some since my understanding is this brand machine is slower to raise it.  Sometimes I feel fine with it, other times I feel like its difficult to get enough air and sometimes harder to exhale so I'm kind of torn on if I should be turning up the min pressure more or not.   Any thoughts you have on this data would be appreciated!
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#2
RE: could use some help getting dialed in
Hi Can'tsleep,

I think you need to give the settings more time and get an average of numbers and an overall sense of how you're feeling.  You're spending a lot of time chasing numbers without giving yourself a chance to get an overall sense of a particular setting.  Overall, your numbers look good but you can probably do better.  Also, it takes some people more time to start feeling better.  Give it time.  If your BP drop is a result of CPAP therapy, then I'd guess you will start feeling better with time.

If these were my charts and based on my limited experience, I would try min 8.5 and max 12 pressure.  Try it for a several days and see how you are making out.  You have primarily Hypopnea events which usually requires higher min pressure. 

More experienced users will likely chime in soon.
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#3
RE: could use some help getting dialed in
First, I am not an expert on Philips machines. Second, can you find a minimum pressure that you are comfortable with? For now I would set the min pressure as high as you are comfortable with up to about 8.5.

Your numbers are good but you seem to have some problem staying asleep some nights. Do not expect for all of your other problems to magically disappear as soon as you start CPAP or even as soon as you get it dialed in. Some people are lucky that way but for many it takes a while which can be up to a year or two. Your BP reduction was a positive sign.

I would say that the first thing that you need to work on is your leak rate which is erratic. High leakage rates can effect the ability of your machine to detect breathing disturbances. Excessive unintentional leaks can mask apnea events or it can cause higher rates of apnea events or it can have no effect at all. It looks to me like some of this may be mouth leaking so a chin strap or a soft cervical collar might help. More and more people seem to be going the cervical collar route. Other than that, I have no experience with nasal pillows masks so I can not offer much help. Hopefully some of our nasal pillows users will chime in.

Some of the charts that you put up made it look like you sometimes have a problem getting back to sleep after awakening. Is that the case?

You have had a very good start. keep working and watching. Be patient. It often takes the body time to adapt to new circumstances or sometimes it is the equipment. Let us know how you are doing.

Best Regards,

PaytonA

Admin Note:
PaytonA passed away in September 2017
Click HERE to read his Memorial Thread

~ Rest in Peace ~
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#4
RE: could use some help getting dialed in
one thing is for darn sure - you are snoring a #WholeLotLess, which must make sleeping environment better for you and any others nearby.

hope you become feeling noticeably better soon.

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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#5
RE: could use some help getting dialed in
Hi cantsleep2017,
WELCOME! to the forum.!
CPAP therapy can take some time to get used to, so just stick with it.
Hang in there for more responses to your post.
Good luck to you on your CPAP journey and let us know how things go.
trish6hundred
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#6
RE: could use some help getting dialed in
Here are your charts to make it easier for people to help.[Image: i8kL7WL.png][Image: FVoSksG.png][Image: IFp6xVc.png][Image: C9e5US8.png][Image: XkqGVol.png][Image: PVYoReQ.png][Image: b6Xqs3U.png]
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#7
RE: could use some help getting dialed in
I'm just guessing and what I would do...I could easily be wrong.
you certainly have pressure swings with good and bad nights. I think a lot of the clusters are positional, sleeping on your back or putting your chin to your chest etc, or even just laying there awake..

Have you read about using a cheap foam cervical collar to keep your airway straight?
For experimenting, the most effective is a backpack to stop back sleeping, or you run enough pressure for the times that you do backsleep (this is what I would do for now, to try and limit variables)

In the last chart, were you awake in the end section? you always discount anything while you are awake.

For now I would run min 12 max 20 to minimise apnea from pressure requirements when backsleeping? and see what's left. you may be able to reduce it back down later.
Get a foam collar if needed and work on positional obstructions for any clusters still there, there are also some leaks to work on.

rule of thumb for me is, fix what you can and to keep increasing min pressure, till they go.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#8
RE: could use some help getting dialed in
Thanks to all for the replies!

While I'm awake I never seem to notice any leaks, and if I wake up usually all seems okay so they must be from tossing and turning. In fact I think I'm doing most of night on my back just because whenever I roll to my side it feels like I start to cause leaks. Do most people find the nuance works for side sleeping or should I be looking at other masks? I'll look into the collar too, it couldn't hurt to try.
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#9
RE: could use some help getting dialed in
I hate to suggest one more thing for you to buy. But for me, a buckwheat chaff pillow ($45 on Amazon, called CPAP pillow) solved my side leaking. I can lay on my side, and move the buckwheat around so it still supports me but doesn't bother the mask.

With this pillow, I also stay in one position all night - I don't move unless I wake up to move.
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#10
RE: could use some help getting dialed in
(06-18-2017, 11:58 AM)Hydrangea Wrote: I hate to suggest one more thing for you to buy. But for me, a buckwheat chaff pillow ($45 on Amazon, called CPAP pillow) solved my side leaking.  I can lay on my side, and move the buckwheat around so it still supports me but doesn't bother the mask.  

With this pillow, I also stay in one position all night - I don't move unless I wake up to move.

Funny you mention that, I already had one saved on amazon to think about...
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