General rule for tweaking pressure - first post

[MartinT]

Greetings,
I got my first CPAP 4 days ago and it's been working well... I hope.
Info:
-AirSense 10 auto sense
-Full face mask - can't find the name on my paperwork
-Prescribed pressure - min 5, max 13, EPR 3 all time
-Ramp off
-Humid - 7 - I live in a very dry climate
-Can't use software. I use Debian 8 Linux and not interested in compiling at the moment. Eventually I could compile a .deb installer for it if you want to use it for those non Ubuntu Debian based users.

The experience:
I have had no problems at all with comfort; I've been wearing it all night and sleeping all night. I haven't slept through the night in at least 38 years.. I also feel no breathing difficulties and there are no detectable mask leaks. No headaches or dizziness. For these positives I feel very lucky.

Now, I don't want to play cowboy with my settings but I think I already have and it's improved the event number considerably. But as I have read here it's not wise to move too quickly... oops.

My apnea event number the first 2 nights were 17.7 and 18 per hour respectively. Waking up has been ok but I have had more grogginess than before the cpap introduction. I've also read that the place to shoot for is <5 events which seems pretty far from where I'm at. So on the 3rd night I raised the minimum pressure to 5.6 and the max. to 14.6. The third night the events went to 10.1 per hour. The fourth night I went to 6 and 15 respectively with the results of 6 events per hour. I suppose I should sit on this for a while. I haven't changed the EPR at all.

My questions: Is there a pattern I should follow from here to make small tweaks if they are necessary? What physical symptoms should I look out for that would signal reducing pressure? I'm wondering if I should reduce sleep medications to counter the grogginess. Any input?
Negative symptoms since starting: more grogginess, more sleepiness in the evenings.
Positive: I am actually sleeping for the first time in 4 decades.

Thanks for this site. It has already been a great help reading.

[robysue]

My questions: Is there a pattern I should follow from here to make small tweaks if they are necessary? What physical symptoms should I look out for that would signal reducing pressure? I'm wondering if I should reduce sleep medications to counter the grogginess. Any input?

I know you don't want to hear it, but without more data, particularly the kind that SleepyHead displays, it's impossible to answer your questions about what further tweaks you might want to consider making.

For example, increasing the min and max pressure settings is not going to do a whole lot if the bulk of the events being scored are CAs. But if there are still a few residual clusters of obstructive events (OAs, Hs, snoring), then a small increase in min pressure might be in order. But you didn't give us a breakdown of the AHI into its component parts, so we really can't tell you whether your current pressure range needs further tweaking.

Knowing more about your leaks is also an important part of the puzzle: Some people leak like sieves and have no memory of it even though the leaks are both large enough and long enough to adversely affect the efficacy of the PAP therapy. Other people are bothered by the slightest leak even when it is not big enough to show up in the leak graph.

You also specifically ask, "I'm wondering if I should reduce sleep medications to counter the grogginess. Any input?" But without known what sleep medications you use, how long you've been using them, and what dose you use, there's just no way anybody can give you even a seat of the pants answer to your question. And it would be useful to also know how many times you are waking up to fiddle with machine or mask "stuff" in the middle of the night.

Negative symptoms since starting: more grogginess, more sleepiness in the evenings.
Positive: I am actually sleeping for the first time in 4 decades.

It could be that your additional grogginess and sleepiness in the evenings is part of "sleep rebound." It's been decades since you've slept well, and now that the machine is allowing you to sleep well, it's craving the high quality sleep that it can now get.

For many people that kind of "sleep rebound" tends to run its course in a few weeks to a couple of months. It can help to pay a bit more attention to your wake up time and your bedtimes: If you can force yourself to get up at the same time all seven days each week, that often helps you get sleepy at the same time as well. Stabilizing the sleep schedule sometimes helps with the daytime and evening sleepiness.

[justMongo]

You really have to know the breakdown of event types.
You really need to see the timing of events too. Like what is the pressure when events are occurring.
So, I would urge you to get a way to run sleepyhead.

Slow down on the changes you have been making. If your determined to operate in the dark -- try moving up the min pressure; but leave the max alone.

Sleep medications may induce central apneas. But, you cannot know without software.

[MartinT]

Thanks... I do want to hear anything that adds to understanding the process, and your comment about the software adds to the importance of using it. No problem. There is minor information within the machines display. It's not as vast as what you mention is necessary but at least it says my mask is not leaking during the night with the highest marks it's capable of. It also says I took the mask off 2 times on first two nights and 1 time on the other two. Those were all within the first half hour to take meds or for initial adjustment as I recall.

Not sure about what to do with the software. The machine has the sd card for data with I can stick anywhere if I had a program to read it or a website that translates it. I'm just taking for granted that the "sorry Linux users" in the SleepyHead section is specific. I could still try it to see if it works, but even though Ubuntu is Debian Linux, Ubuntu comes with a lot of optional compilation bits that other systems don't necessarily have. If SleepyHead has dependencies that pure Debian does not, they can be installed. Are there other programs or on-line sites that read cpap data?

Your last comment on sleep rebound is very enlightening. Thanks

[MartinT]

You really have to know the breakdown of event types.
You really need to see the timing of events too. Like what is the pressure when events are occurring.
So, I would urge you to get a way to run sleepyhead.

Slow down on the changes you have been making. If your determined to operate in the dark -- try moving up the min pressure; but leave the max alone.

Sleep medications may induce central apneas. But, you cannot know without software.

Thank you... I'll see what I can do about the data ??? Maybe a last resort would be a virtual box operating system with Ubuntu.

I will also take your advice about the pressure changes. I imagine it would be reasonable to drop the max pressure closer to the original prescribed amount and I'll leave the minimum where I last put it... then wait and watch...

[trish6hundred]

Hi MartinT,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy and fine-tuning it to better help you.

[Beej]

I was thinking using a virtual Windows within your Linux might be the way to go.

[MartinT]

Hi MartinT,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy and fine-tuning it to better help you.

Thank you. This looks like a place with lots of info to keep me in line. I always need a little guidance with new toys. So far, I never imagined the difference a CPAP would make and I'm only starting.