After 11 Months Need a Reality Check

[AndyB]

I need a reality check from some of the experts on this great forum. Briefly, my APAP therapy is effective, but I'd like to achieve better results than I get now. My question: is that reasonable, or should I be satisfied with the efficacy level I'm getting now (don't fix what isn't broken)?

I've used my machine every single night for the last 11 months, averaging about 7 hours a night of use while asleep. Here's a summary of my results for the last 7 months (I've excluded the first 4 months, which weren't terrible, but not respresentative of my current situation since I was fiddling with different masks, chinstraps, mouth tape, and becoming acclimated to sleeping with an APAP machine):

AHI -- monthly averages between 2.0-2.7, mostly in 2.4-2.5 range
OSI -- monthly averages between 0.2-0.5, mostly in 0.2-0.3 range
HI -- monthly averages between 0.5-0.8, mostly in 0.6-0.7 range
CAI -- monthly averages between 0.9-1.9, mostly in 1.4-1.6 range
Leak Rates -- 90% rate monthly averages between 1.2-7.2%, mostly in 6-7% range; 0% over the Leak Threshold

I've made a few modest pressure adjustments over the last seven months, with little apparent effect. In November the setting was 9.6-13.6 cm, December was 9.6-14.0, January-February was 10.0-14.0 and March-May has been 10.0-12.8. My in-lab sleep study titrated me to 11.0 cm CPAP.

I'd like to reduce the Clear Airway events, now that I've adjusted to APAP therapy, but I'm unsure whether that's a reasonable endeavor.

Attached is a screencast.com link to my monthly CPAP stats.

Thanks for any and all insights, comments, suggestions, etc. -- this forum is a terrific resource and I'm very grateful for the education and support all of you provide.

AndyB

http://screencast.com/t/EOyIuWlVWWA

[justMongo]

What duration are the clear airway apneas? If they are like 10 to 12 seconds (i.e. - short) then it's not a big deal.
Perhaps you could zero in on a the flow rate around a typical CA and post that.

Slight possibility that reducing EPR might clear up CAs -- as lower IPAP can blow off too much CO₂.

Frankly, I think you're pretty well dialed in.

[AndyB]

What duration are the clear airway apneas? If they are like 10 to 12 seconds (i.e. - short) then it's not a big deal.
Perhaps you could zero in on a the flow rate around a typical CA and post that.

Slight possibility that reducing EPR might clear up CAs -- as lower IPAP can blow off too much CO₂.

Frankly, I think you're pretty well dialed in.

Thanks justMongo,

About half the time my CAs are 10-14 sec long, but most of the rest of the time they are 15-25 secs long, with occasional CAs over 25 secs long.

I couldn't think of a good way to post a "typical" CA since there are over 5,300 CAs in my data set. However, I exported my data from SleepyHead to Excel, and then created a histogram of CA duration frequencies. The data show that the "normal" duration of my CAs (i.e., the first standard deviation) is 10-19 secs. The second standard deviation (together with the first standard deviation, encompassing 95.45% of all CAs) is 29 secs. What, me, data obsessed?

Thanks,
AndyB

http://screencast.com/t/FSlT9pZUIp1j

[PoolQ]

need to see a typical night, detailed graph. there is a thread up top on what and how to post it.
You do look pretty good there, how do you feel? Do you feel like you are getting enough sleep?
If all that is good, you may consider getting a recording O2 meter and verify that your apneas are not dropping your O2 levels.
if all this turns out to be good, they relax and enjoy what I hope I can eventually get to.

[OpalRose]

Here is a helpful link for posting your information from SleepyHead.
http://www.apneaboard.com/wiki/index.php...ganization

[Sleeprider]

Andy, your CAI is well below thresholds of concern for therapy. Pressure won't solve the problem, and I presume pressure reductions result in increased RERA or obstructive events. I reached a point in my own therapy where I just accepted some CA events as a better option to higher RERA. If you have experimented with various pressure and EPR alternatives, then you know the results and are in the best position to discuss the pros and cons. Most CA at the level described in your data comes from rolling over, swallowing and just breath holding. You probably do it all day as well. Why worry?

At the level of events you are having, your daily obsession with data is not working to your advantage. Get your therapy to where you have good results and a comfortable restful sleep, and call it good. You will not be graded on your normal residual apnea, especially incidental CA.

[AndyB]

Thank you all, for your thoughtful and helpful comments. I am very grateful for the terrific support this forum provides.