Hit Stuck Point - Need Help

[RWhipkey]

Love the new Avatar, and I'm a fan. The back-story on this is when Octrocket became an Advisory Member I made the same request.  We might not be far apart geographically as I'm next door in Westmoreland County.  Looks like you guys might see some snow this week.  I appreciate your efforts to up-size the graphs.

We already got 3-5 inches of heavy snow late today.  We're real close.  My daughter and her family are in North Huntingdon (4 grandchildren); and my 2 sons and their wives are in Pittsburgh (1 more grandchild).  Four of us graduated from Pitt and two from Carnegie Mellon.  I'm over your way often.  Bucs not helping themselves inthe off season, I'm afraid.

[Sleeprider]

Thanks for the update. On your first graph, I was ready to declare a resounding success; not so much with the second. Take your minimum pressure up by 0.5, and that should help with the hypopnea. Your pressures are still pretty low. Do you have any restrictive or obstructive pulmonary condition you are aware of (COPD / asthma)? Your tidal volumes are quite low unless you are a small individual, and this low volume may explain some of the hypopnea event rate we see. Notice there are several periods where you have very shallow breathing during the night, and those times are completely free of events. The hypopnea only occur during periods where you have greater respiratory volume, and I suspect that you just have momentary shallow breathing interspersed in those times. This is mostly prevalent in the later 2.5-hour session.

[RWhipkey]

Thanks for the update.  On your first graph, I was ready to declare a resounding success; not so much with the second.  Take your minimum pressure up by 0.5, and that should help with the hypopnea.  Your pressures are still pretty low.  Do you have any restrictive or obstructive pulmonary condition you are aware of (COPD / asthma)?  Your tidal volumes are quite low unless you are a small individual, and this low volume may explain some of the hypopnea event rate we see.  Notice there are several periods where you have very shallow breathing during the night, and those times are completely free of events.  The hypopnea only occur during periods where you have greater respiratory volume, and I suspect that you just have momentary shallow breathing interspersed in those times.  This is mostly prevalent in the later 2.5-hour session.

OK. I will move minimum up to 7.0 tonight.  I don't have any COPD or asthma, nor am I small, 5' 10" 180 lb.

[RWhipkey]

To Sleeprider and All

Thank you all so much for your help thus far. This forum and its members have been a godsend for me.

This post is a continuation of my thread "Hit Stuck Point - Need Help". In post 13 of that thread, I agreed with Sleeprider to raise my minimum APAP pressure to 7.0 and try it for a week. I did and responded with 2 posts (#'s 14 and 15) in which I jumbled the SleepyHead attachments and which leaves them too confusing. When I realized this, it was too late to edit them. This post corrects them and should be easier to follow. Please ignore posts 14 and 15 of the previous thread.

I moved the minimum pressure setting on my Dreamstation to 7.0 (max is 12.0) on January 24. I also bought a chinstrap and have used it since January 24. AHI from January 24 through January 30 has been 1.93, 2.07, day off for cold, 4.21, 1.42, 2.34 and 1.97 for the week (the 4.21 outlier may have been from lingering congestion from my cold). In addition leaks have all but disappeared. As a result, the dry mouth has been alleviated and is now tolerable. Not sure how tight to make the chinstrap; don't want to cause dental problems. Although the numbers have gotten better, I can't say that my sleep has improved. I don't seem to be able to sleep for long periods. In fact, my sleep seems worse in that way than what I got prior to therapy. Is this typical of beginning CPAP? Some mornings I can't go back to sleep, so I remove the mask and try to get a few more hours. Basically I don't feel rested in the morning, but I still can workout at my usual levels and don't seem too tired during the day once I get going. Perhaps all of this is normal as I find it not easy to adjust to the mask and chinstrap as well as the whole new experience. Below are two days from the week; the best on January 28 and last night. The first thumbnail is the entire night for each and the others are the sessions. Please help me interpret and change any settings accordingly. (Can the Flex exhalation setting at 3 be causing some problems; that was the DME's setting)

January 28:







January 30:

[Crimson Nape]

This is more out of curiosity; I'm a Resmed user and I'm curious.  .  .  Does a Phillips machine show flow limitations?   If not, what's in its place?

[RWhipkey]

This is more out of curiosity; I'm a Resmed user and I'm curious.  .  .  Does a Phillips machine show flow limitations?   If not, what's in its place?

Yes.  If you click on any of the thumbnails, you will see flow limitations on the left.

[Crimson Nape]

I see it now. The Resmed reports it in its own graph and looks muck like the Snore graph.

[Cranberry Ray]

Hi RW. For the most part the therapy looks to be effective for the periods you can keep the mask on. It is normal for most people to take some time to adjust to wearing a mask all night and having air blowing into your sinuses. It does take persistence to get through the break-in period but is very much worth it. What are some of the reasons you are waking up and removing the mask? Your leak rates look great so I don't suspect that's the cause. I think it would be best to get you tolerant of the therapy before trying to fine tune any settings. Hard to get a good overall view with short samples.

Hang in there, it will get better.

[RWhipkey]

Thanks Cranberry

I really don't know why I'm waking up.  Not leaks and no longer dry mouth.  I guess it's a matter of just getting used to it.  BTW, last night was the best sleep night I had yet in terms of feeling rested and I logged over 8 hours total with three wakeups; however AHI was up to 3.59.  So, I guess its not just about the numbers.  Thanks for your encouragement.

[Sleeprider]

Throughout the graphs you posted, the only events are a few CA and some H. There are also numerous flow limitations. None of the events or flow limits occur in a recognizable pattern, and RERA is actually pretty good. I would be very reluctant to shoot for consistent zeros in AHI when treatment seems overall really good. With your minimum pressure at 7, and max at 12, the auto pressure is nearly constant in spite of the flow limitations.

These results actually surpass my expectations for this point in your therapy, especially considering the difficulties you had in dealing with leaks, and the fact we really aren't treating conventional obstructive apnea. After less than a month, you have consistently good results, and are starting to feel some of the tangible benefits of the therapy, or at least less discomfort. As for not feeling as rested as you hoped, you are showing two days of data in 6 charts, so your sleep is highly fragmented. I think you can combine those sessions into single charts by toggling the sessions on and off in that session length bar at the bottom of the summary pane.

I don't think the problem at this point is therapy related, but comfort and sleep hygiene. I don't know what is disrupting your sleep or causing the arousals. As you try to track this down, I can only suggest you take note of what is disruptive to your sleep. You have solved leaks, and to be honest you have no residual obstructive apnea to address. Most of your residual AHI is hypopnea, and if you were using a bilevel, I would increase pressure support to try to resolve that and the flow limits. That isn't really an options with your CPAP. You probably have a physician follow-up coming, and this may be an issue to talk about there.