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Best Practices lower AHI/RDI in first 30 mins of sleep - Printable Version

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Best Practices lower AHI/RDI in first 30 mins of sleep - WillSleep - 11-10-2017

Greetings!

I am new here.  Great Community!    like

I searched and read lots of threads but did not yet see this answered so I am posting the question.


I am currently unemployed and without insurance but needed to take action NOW.  I have a strong engineering measurement, experiment design & machine automation background so I have begun a self education process and collecting & doing the following nightly:
- PulseOx recording, threshold alerting & charting (good alone or also with Sleepyhead data review sessions)
- Sleep Phase monitoring 
- All night high sensitivity sound recording (occasional insightful clarifications or inputs)
- Making small incremental changes and result assessments via a DoE process model 
- Last three nights of Dreamstation 500 APAP input Sleepyhead



My quest via this post:  Improve AHI/RDI for the last 12 of the first 15 mins of sleep, which have been the worst part of each night I have been capturing data. 


Measurement results:
- As far as my wife and I can tell, when I go to bed good and tired I fall asleep (completely out) in 10-15 seconds from when my head hits the pillow 
- Confirming the longer running PulseOx results, three nights Dreamstation data via Sleepyhead shows that my 15 mins of sleep start with what looks like 3 mins of blissful slumber followed by 12 mins of hell. 
 -- Three night's Event Averages for that 12 min period:  5 OSAs, 3 Hs, 2 CAs, 1 FL  and two rude awakenings by the PulseOx alerting me that SpO2 has dropped below 90%.
- The remainder of each of the three 8 hour sleeps shows much lower AHI & RDI  

The First Question:  Is it possible to configure the Dreamstation 500 Auto-CPAP with the following execution recipe?  
- Ramp start pressure:  5cm
- Ramp time:  5 mins
- APAP Min Phase 1:   Set APAP Min to 13cm for first 20-30 mins after ramp completes
- APAP Min Phase 2:   Set APAP Min lower to 9cm for remainder of night   

The Second Question:  Are there known Best Practices  or links for how to configure the DreamStation for this time period or how to test Dreamstation configurations for optimal configs to address the early sleep chaos time period?  

The Third Question:   Am I barking up the wrong tree?   Better or Other good approaches to better AHI during this time period?
- Links to good threads or wikis I should just go read?  
- Community wisdom on best ways to improve AHI when first asleep? 

 
Many thanks!
James

RE: Best Practices lower AHI/RDI in first 30 mins of sleep - OpalRose - 11-10-2017

May I ask what your pressure settings are, (minimum and maximum) your AHI and breakdown of AHI, and what is your 90% pressure reading?  

To answer your first question...your Apap can’t be set in two phases, well unless you want to set an alarm clock to wake you and change it yourself. Grin

This is what I suggest....turn ramp off.  If you can fall asleep in 10 to 15 seconds, there is no need for ramp.

We really need to see some data to advise on pressure settings.  Follow the tutorials in my signature line, and use imgur to post a screenshot of the daily page here.  Since you are new, insert a space in the link,
example:  h ttp....

In the meantime, a good rule of thumb to follow is this:  figure out your 90% pressure, then set minimum pressure at 1 to 2 below that and 2 above that number.  This way you have a  range to best treat your Apnea events.  

You want your minimum pressure to be set close to the 90% pressure.  Why make the machine work harder to treat events?

RE: Best Practices lower AHI/RDI in first 30 mins of sleep - Sleeprider - 11-10-2017

It might be interesting to look at your data and go from there. If you are capable of falling asleep as your head hits the pillow, you probably don't need ramp. You cannot setup the auto CPAP for changing minimum pressures, so you can choose 9 or 13, but I would just go with what works to knock out events under worst case. If you need a pressure of 13 cm shortly after falling asleep, I would recommend a minimum ramp pressure of 9 for 5-minutes, and minimum pressure of 13. This all assumes the cluster of early apnea is obstructive. Also, the pattern you're suggesting might benefit from positional therapy as an alternative to higher pressure. Finally, turn off the SpO2 alarm. You don't need to be wakened for a 90% SpO2. If I was setting an alarm, it wouldn't be above 85%, anything else, I'll fix it in the morning.

Welcome to the forum. I'm sure we can find some ways to channel your inner geek to get some better sleep.

RE: Best Practices lower AHI/RDI in first 30 mins of sleep - WillSleep - 11-11-2017

(11-10-2017, 08:11 PM)OpalRose Wrote: 1. In the meantime, a good rule of thumb to follow is this:  figure out your 90% pressure, then set minimum pressure at 1 to 2 below that and 2 above that number.  This way you have a  range to best treat your Apnea events.  

You want your minimum pressure to be set close to the 90% pressure.  Why make the machine work harder to treat events?

...

2. May I ask what your pressure settings are, (minimum and maximum) your AHI and breakdown of AHI, and what is your 90% pressure reading?  

MANY THANKS!

1.  That is a good tip.

 
2a.  After a lot of reading and studying Sleepyhead results yesterday I changed the Dreamstation APAP settings  to Min = 10cm,  Max = 17cm,  FLEX=OFF.

2b.  AHI:  Last night's AHI was 5.83 (CA=1.22, OA=2.85, H=1.76)    Avg AHI for four nights = 7.7,  L/H =  4.37/12.35 
Note: The AHI of 12.35 was the last night on factory default 4/20 settings

2c.  Last Nights 90% Pressure = 13 cm,  Avg for four nights ~12.4cm
(11-10-2017, 08:11 PM)OpalRose Wrote: We really need to see some data to advise on pressure settings.  Follow the tutorials in my signature line, and use imgur to post a screenshot of the daily page here.

 Since you are new, insert a space in the link,   example:  h ttp....
Will do that now.

RE: Best Practices lower AHI/RDI in first 30 mins of sleep - WillSleep - 11-11-2017

(11-10-2017, 08:39 PM)Sleeprider Wrote: If you are capable of falling asleep as your head hits the pillow, you probably don't need ramp. 

Oh my gosh, that falling asleep so fast might be a thing of the past.   

My face is sore from the mask and now I am more rested than before..  last night was rough.

RE: Best Practices lower AHI/RDI in first 30 mins of sleep - WillSleep - 11-11-2017

(11-11-2017, 01:49 PM)WillSleep Wrote:
(11-10-2017, 08:11 PM)OpalRose Wrote: 2. May I ask what your pressure settings are, (minimum and maximum) your AHI and breakdown of AHI, and what is your 90% pressure reading?  
MANY THANKS!

 
2a.  After a lot of reading and studying Sleepyhead results yesterday I changed the Dreamstation APAP settings  to Min = 10cm,  Max = 17cm,  FLEX=OFF.

2b.  AHI:  Last night's AHI was 5.83 (CA=1.22, OA=2.85, H=1.76)    Avg AHI for four nights = 7.7,  L/H =  4.37/12.35 
Note: The AHI of 12.35 was the last night on factory default 4/20 settings

2c.  Last Nights 90% Pressure = 13 cm,  Avg for four nights ~12.4cm
(11-10-2017, 08:11 PM)OpalRose Wrote: We really need to see some data to advise on pressure settings.  Follow the tutorials in my signature line, and use imgur to post a screenshot of the daily page here.      Since you are new, insert a space in the link,   example:  h ttp....
Will do that now.

This image is my first attempt to follow the tutorial.  Please freely coach on improvements.

https://imgur.com/hbb2Jt0.png


[Image: hbb2Jt0l.png]

RE: Best Practices lower AHI/RDI in first 30 mins of sleep - Sleeprider - 11-11-2017

You no longer need to use a space to post URL links.  Interesting chart, and I interpret most of the flagged OA as being CA based on the gradual waning of respiration to the apnea, and gradual recovery of volume.  If AHI becomes worse with increasing pressure, or these events do not respond to higher pressure, that would convince me they are incorrectly flagged, and you may benefit from a change in therapy.  It might help to zoom in further on this wave for so we can see if it includes flow limitation which would be obstructive.

[Image: hbb2Jt0.png]

RE: Best Practices lower AHI/RDI in first 30 mins of sleep - WillSleep - 11-11-2017

Sure.

Which times frames would you like me to zoom into further?

Repost the whole 24 mins but zoomed into 2?, 3? or 4 segments?

Or are there specific times you would like a closer look at?  


Also, SH can not read my Pulse Ox data but use and I can produce PulseOx trendline graphs to line up with the Events in the Flow Rate bar if you guys would like to see those.

James

RE: Best Practices lower AHI/RDI in first 30 mins of sleep - WillSleep - 11-11-2017

I am sad to say I have a new SH stupid user question.

At the mention of Flow Limitation I was looking to see if I could add the Flow Limit horizontal chart I saw in the "Organize SH Tutorial" and again could not find it .. which I assume means Dreamstation is not producing the required data.

MY QUESTION: Some how in the process of looking for the Flow Limit chart I turned off the event labels in the "Flow Rate" chart, labels like CA, OA, VS, H, etc. I have looked three times but don't see it, how in SH do turn the event labels in the Flow Rate chart back on?

RE: Best Practices lower AHI/RDI in first 30 mins of sleep - Walla Walla - 11-11-2017

At the very bottom there's a box that says flags. Make sure the events you want are showing green.