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q on switching to APAP
#1
Dear all,

I never had a good sleep study (didn't sleep) and doc thought he saw some centrals in the few minutes of sleep, and prescribed CPAP at a setting of 7. I get decent results, AHI average of say 7-8. But I am woken by snoring and apneas.

I have decided to experiment with APAP, moving from a resmed s9 to a Remstar 60 machine. I tried mix 6 and max 9. Sleep felt better. AHI reported similar: 6.71. But the first night of data looks *very* different in sleepyhead. There are now hardly any CA, but lots of RERAs seen, and some periodic breathing. Snores marked now, of two types.

Do the machines detect events differently? How do I compare?
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#2
It sounds like you might need a bit more pressure. Download SleepyHead (looks like you have it), and use the first two links in my signature to learn how to organize charts and post them for the forum. Things like flow limitations, hypopnea and RERA can usually be cleaned up with very little additional minimum pressure. If you're having OA, then it might have to go a bit higher. The PRS1 60 series Auto is a very good machine. You need to give it a running start as it is a bit slow to adjust upward for obstructive events, and if minimum pressure is too low, it drops off pressure. What is your average and 95% pressure?


Sounds like you've done a good job taking charge of your own therapy. Welcome to the forum.
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#3
Yes, I added screenshot from Sleepyhead. I actually adjusted during the night -- I think I started at max 8, then 8.5, then 9.

In the end, ave pressure 7.9 and 95% was 9.

thanks!
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#4
Seems like you know what your doing. If your are using the ramp feature, you may do better without.
A good pressure range based on your 95% number looks like 7cm minimum and 10cm maximum.

Keep us posted, the AHI should drop some.

Next time you post a screenshot, get rid of the calendar and pie chart. That will let us see more stats at the bottom.
Sleep-well
OpalRose
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#5
Hi zoechow,
WELCOME! to the forum.!
I wish you good luck with your CPAP therapy, hang in there for more responses to your post.
trish6hundred
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#6
By looking at the chart I'd set min to 8 and max to 11. I have the same machine. Your max is topping out and holding there for periods of time.

I'm guessing all said and done to get to a who of 1 or so you'll wind up about min of 8.5 or 9 min and 13 or 14 max though with the min set correctly it'll likely never go above 11 or 12.
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#7
Dear All,

Thanks so much for your comments and encouragement. I am posting the second night screen shot. Higher AHI. But a longer first period of sleep. I was scared to increase pressure too much, so I had a min of 6.5 and max of 9.5. If I understand your comments, the data seem to bear out the suggestion of the need for a higher min pressure, at very least.

Unless I hear otherwise, I will raise both pressure numbers again.

thanks in advance for any help!


Attached Files Thumbnail(s)
   
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#8
You are getting good time on the machine, although there are too many breaks which is disruptive to sleep. Your mask is leaking, but not too badly, and this should improve as you adapt. Everything is obstructive in that screenshot; OA, H, FL, RERA, and snores. You will probably need a minimum pressure of 8-9 and probably need up to 14 maximum pressure. It's fine to get comfortable and work your way up to the higher pressure that s going to be needed.

A couple questions. Did you have a titration sleep study where you slept with CPAP and alternative pressures were evaluated? What is causing the therapy breaks? A lot of events ocurred near the end of the night when the machine never reached therapy pressure in time to stop the events. Part of the problem is the low ramp pressure. I would turn off ramp or increase the pressure. That can actually help you get the mask fit better.
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#9
(12-22-2016, 02:45 PM)Sleeprider Wrote: Did you have a titration sleep study where you slept with CPAP and alternative pressures were evaluated? What is causing the therapy breaks?

I barely slept at the sleep study, so not much by way of results. They thought they saw centrals, and so wanted to start with lower pressure (7). Breaks: I've always woken up a lot, and go to the bathroom. That first period of 2.5 hours is pretty long for me, but hoping it can get better.

Will raise the pressure slowly and the ramp level.

Thanks!
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#10
As I said, it's worth watching the CA, but everything is pointing to OA right now. If it does turn out you have mixed apnea, its usually a balancing act where we try to keep pressure as constant as possible without using much EPR or flex. So far, you are all OA. Taking it slowly wlll get you there in a few days or weeks. No problem. It seems you have a pretty good sense of what needs done.
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