jamieboss1- Therapy Analysis

[jamieboss1]

Hi Everyone,

I just started CPAP therapy last week (for mild apnea) and I was hoping to gain some insight into settings, etc to improve my AHI. I've been reading a bunch of threads and adjusted my pressures based on what I've learned so far. 

During my in-lab sleep study:
AHI index: 6.7, nadir O2 saturation at 90%
Test showed both Obstructive and Central Apneas.

This is the lowest AHI I've registered so far.  Anything I should try adjusting or is this a good start? 

Thanks so much in advance, 
Jamie

[Expat31]

Hello, it is certainly a good beginning. Your graphs are well presented, and with the statistics and settings easily visible, it helps a lot! 

For starters I would increase your minimum pressure to 10, for reducing obstructives and hypopneas. 

Concerning your centrals, were they significant in your sleep study? Do you have the actual breakdown of your 6.7 AHI, amongst centrals, obstructives and hypopneas? 

However, currently your centrals could be machine induced, and likely will  dissipate over time. If persistant, a reduction in EPR may help. 

You have ramp set to auto. Best to have OFF, if possible, as you get no therapy benefit these ramp periods.

[jamieboss1]

Hello!


Thank you so much for the quick reply and your suggestion to increase the lower pressure threshold. I'll certainly try that tonight. 

Regarding centrals, here is the txt from the sleep study. Its worth noting that I was only able to sleep around 3 hrs because the room was unusually warm. 

Please let me know your thoughts. 


"The overall apnea-hypopnea index was mild at 6.7 events/hr with a nadir 02 saturation of 90.0%. The REM-specific index was 0.0 events/hr. The supine index was 0.0 events/hr. The obstructive apnea index was 0.3 events/hr There was 1 obstructive apnea with a mean duration of 16.0 seconds. There were 10 obstructive hypopneas with a mean duration of 19 3 seconds. There were 10 central apneas with a mean duration of 13.7 seconds. There were 23 respiratory effort-related arousals resulting in a RERA index of 7.4 events/hr. The respiratory disturbance index, vhich unlike the apnea-hypopnea index includes RERAs, was mild at 14.1 events/hr. Mean saturation was 96.0% 100.0% of the study time was spent with a saturation in the 90-100% range. 0.0% of the study time was spent with a saturation below 90%. There were 0 arousals related to respiratory events with an index of 0.0 arousals/hour. There were 43 Spontaneous arousals noted with an index of 13.8 arousals/hour. The etiology of some of these was unclear.

Snoring was mild.



Mean heart rate was 63.2 bpm. Heart rate ranged from 51.0 bpm to 90.0 bpm.
The patient did display a normal sinus rhythm." 



Thanks again,
Jamie

[super7pilot]

That's a pretty short sleep lab. But with 10 centrals and 10 Hypopnea's to 1 Obstructive. That might be a more complex fix. Others will come along to verify. But there is an apnea teeter totter analogy. Obstructive,Hypopnea events are on one side with Centrals on the other. Increasing pressure and or EPR treat OA's H's but increase Centrals.

could you zoom in on one of your CA's and post that. lots of folks get treatment emergent CA's. You normally see on your chart if a CA is a real central or a treatment caused one.

[jamieboss1]

That's a pretty short sleep lab. But with 10 centrals and 10 Hypopnea's to 1 Obstructive. That might be a more complex fix. Others will come along to verify. But there is an apnea teeter totter analogy. Obstructive,Hypopnea events are on one side with Centrals on the other. Increasing pressure and or EPR treat OA's H's but increase Centrals.

could you zoom in on one of your CA's and post that. lots of folks get treatment emergent CA's. You normally see on your chart if a CA is a real central or a treatment caused one.

Thanks for this. I really appreciate it. Here are 3 zoomed in screenshots showing the CA events.
Please let me know your thoughts. 
Jamie

[super7pilot]

You need to zoom in a lot more. Here is an example from my chart. This is a classic big breath that clears Co2 and my body said, Take a break from breathing until the Co2 level comes back UP into the normal range.

   

[jamieboss1]

I see, thank you. I’ll try to upload a new image in the morning.

[jamieboss1]

You need to zoom in a lot more. Here is an example from my chart.  This is a classic big breath that clears Co2 and my body said, Take a break from breathing until the Co2 level comes back UP into the normal range.

Ok, how’s this?

[super7pilot]

OK, As you are so new to PAP. Therapy can be all over until your body and brain (attitude/sleep hygiene) get used to therapy.

I'd say to set your minimum pressure to your median pressure as reported by your machine. Which in your case would be 10.4cm. Your max of 15cm is fine.

Once the pressure is increased and we see that your OA's improve. Then you can experiment a bit with your EPR. Most folks like at least a bit of EPR as it just feels more comfy. But the higher the EPR setting, the more likely low Co2 Clear Airway events will be present. Again, As you are new to therapy. CA's are even more likely from "Treatment Emergent CA's"

Your pressure variance was not bad for being new to PAP. 10.48-12.9=2.42cm range isn't horrible. But we want to work on decreasing that pressure rise as much as possible. Large sharp pressure increases WILL wake you up. Which is why most experienced pap users here hate the lazy Dr's recommended 4-20 let the machine sort it out pressure settings. It is highly counter productive.

One important aspect of pap therapy that most don't even think about is sleep hygiene. So many do things in bed that end up making the body/mind associate the bed with everything but sleep. Such as watching cat videos on your phone, games, reading, watching TV. I had a Dr. once tell me your bed is for sleeping and adult fun time with your partner, NOTHING ELSE.
Then there is the environmental bedroom factor. If your area lacks humidity (mine does). Run a humidifier. A cool bedroom is also better for sleep as our bodies do rest better when it's cooler at night. use as flat a pillow as you can to prevent bending your neck and causing positional apnea.

Aches and pains and various drugs can severely effect pap therapy.

Pain was my kryptonite. I was suffering from dry eye syndrome. And it was waking me up. And despite my under 1AHI. I felt like dog poo because I wasn't sleeping as much as I should. once I got my dry eye under control. My restful sleep increased greatly to the point that my BP dropped enough to ditch one of my BP meds. So as hard as it might seem. Be patient and work on any outside influences that can effect good sleep.

[jamieboss1]

OK, As you are so new to PAP. Therapy can be all over until your body and brain (attitude/sleep hygiene) get used to therapy.

I'd say to set your minimum pressure to your median pressure as reported by your machine. Which in your case would be 10.4cm. Your max of 15cm is fine.

Once the pressure is increased and we see that your OA's improve. Then you can experiment a bit with your EPR. Most folks like at least a bit of EPR as it just feels more comfy. But the higher the EPR setting, the more likely low Co2 Clear Airway events will be present. Again, As you are new to therapy. CA's are even more likely from "Treatment Emergent CA's"

Your pressure variance was not bad for being new to PAP.  10.48-12.9=2.42cm range isn't horrible. But we want to work on decreasing that pressure rise as much as possible. Large sharp pressure increases WILL wake you up. Which is why most experienced pap users here hate the lazy Dr's recommended 4-20 let the machine sort it out pressure settings. It is highly counter productive.

One important aspect of pap therapy that most don't even think about is sleep hygiene. So many do things in bed that end up making the body/mind associate the bed with everything but sleep. Such as watching cat videos on your phone, games, reading, watching TV. I had a Dr. once tell me your bed is for sleeping and adult fun time with your partner, NOTHING ELSE.
Then there is the environmental bedroom factor. If your area lacks humidity (mine does). Run a humidifier. A cool bedroom is also better for sleep as our bodies do rest better when it's cooler at night. use as flat a pillow as you can to prevent bending your neck and causing positional apnea.

Aches and pains and various drugs can severely effect pap therapy.

Pain was my kryptonite. I was suffering from dry eye syndrome. And it was waking me up. And despite my under 1AHI. I felt like dog poo because I wasn't sleeping as much as I should. once I got my dry eye under control. My restful sleep increased greatly to the point that my BP dropped enough to ditch one of my BP meds. So as hard as it might seem.  Be patient and work on any outside influences that can effect good sleep.

Hi, 
I can’t thank you enough for this detailed reply. 
I’ll certainly adjust the pressure settings and see how it goes. 
It’s wild that the Dr’s recommend a blanket pressure range and expect people to have positive results. 
Thank you again and I’ll report back! 
Much appreciated, 
Jamie