Hit Stuck Point - Need Help

[RWhipkey]

Sleeprider

Thanks for your input.  I don't have a physician follow up because here in Somerset, they don't even give you a physician.  The DME's RT is all I've got and he is part-time until they make a permanent hire and he never saw the Dreamstation APAP before.  You guys are all I've got.

The charts in this thread are jumbled and I reposted them correctly in a thread titled "Getting Better Numbers - Still Need Advice".  I feel like a technological idiot for this.  I don't know if relooking at them will give you any better insight.  In writing back and forth with SuperSleeper, I got things clarified and I don't know if he will combine threads for clarity or not.

Nonetheless, based on the general advice on this forum, I increased my minimum pressure to 7.5 last night and dropped the Flex to 2.  I actually logged 8 hours and only woke up twice.  Both times I went right back to sleep.  This was the most comfortable night I've had so far and I feel rested for the first time.  However, AHI increased to 3.59 (CA - 1.11, Hypopnea - 2.48, no obstructives), leaks up slightly but still very low (.27 leak rate), flow limitations about the same (.37).  Nothing else stands out to me.

Do you think I should leave minimum at 7.5 or drop back to 7.0 and leave the Flex at 2 or go back to 3?  Whatever you suggest, I will be willing to stick with it for as long as you think is appropriate.  I can post results from Sleepyhead if you need them.  I'm sorry that I've taken up so much of your time and that I've struggled with clear postings.  I too agree that, for the first time I feel that I'm making progress.  I need to give it time and accept that it will take time.

[Sleeprider]

Your move to 7.5 makes a lot of sense, and in the case of CPAP, results count. I was considering advising making further changes in .5 increments, and sometimes Flex makes a difference in events like you are showing. Well done on taking the initiative. You are right that looking at the split sessions was confusing. I took a look at your other graphs and they make more sense http://www.apneaboard.com/forums/Thread-...-Still-Nee d-Advice?pid=190195#pid190195

It is surprising to me, you are not getting a more substantial pressure increase from the flow limitations, but we can always do it manually by adjusting minimum pressure, which is what you did. Let's see if this moves things in the right direction. I do prefer when information is kept to a single thread. It's a lot easier to track, and it is hard to reconstruct the history when it is split into multiple locations. Since we are trying to establish trends, history matters. Good luck!

[RWhipkey]

Your move to 7.5 makes a lot of sense, and in the case of CPAP, results count.  I was considering advising making further changes in .5 increments, and sometimes Flex makes a difference in events like you are showing.  Well done on taking the initiative.  You are right that looking at the split sessions was confusing. I took a look at your other graphs and they make more sense http://www.apneaboard.com/forums/Thread-...-Still-Nee d-Advice?pid=190195#pid190195

It is surprising to me, you are not getting a more substantial pressure increase from the flow limitations, but we can always do it manually by adjusting minimum pressure, which is what you did.  Let's see if this moves things in the right direction.  I do prefer when information is kept to a single thread. It's a lot easier to track, and it is hard to reconstruct the history when it is split into multiple locations.  Since we are trying to establish trends, history matters.  Good luck!

Thanks so much Sleeprider.  I will leave my pressure at 7.5 minimum and 12.0 maximum.  In addition, I will keep the Flex at 2.  After we gather data at these settings, we can decide if any more changes are appropriate.  With last night's experience I have gained new optimism; the journey continues.

I did communicate with Supersleeper about combining the posts so that we have history in one place.  We'll have to wait to see if he can do so.

[Newbee2016]

I was started on a 6-13 setting and been increasing the minimum pressure as AHIs were 3-5 range. Based on Sleepriders suggestion I upped it further to 8.5 and then 9 when I switched to the Dreamstation. I was getting AHIs in 2-3. Decided to cut C-flex from 2 to 1 and then completely off. Now I'm getting AHIs below 1 and because of that the machine need not change pressure to anywhere near the maximum setting. I do wake 2-3 times in the night at setting of 9 (unlike @ 8) but I think it's the body getting used to the pressure. My humidifier is set for adaptive 4 so I don't get wet cheeks or nose but the sinuses seem a bit stuffed as are the ears.

Just some views from another PR user.

[Sleeprider]

^^ we need a 'like' button. Thanks for the feedback!

[Newbee2016]

^^ we need a 'like' button. Thanks for the feedback!

[RWhipkey]

Newbee

Thanks for your response.  Your situation seems very similar to mine in some ways.  I would like it if you kept me updated on your progress and shared your experiences with me.  Likewise, I will always be glad to respond to you.


Thanks again

[RWhipkey]

Am I moving in the right direction? Attached is a PDF file with the details summarized from SleepyHead for the last 11 days.  Basically, it covers the period from January 24 (the point at which I added the chinstrap) through last night.  Leaks were solved (and remain solved) with the chinstrap.  As you can see, total AHI has increased since I increased the set minimum pressure from 7.0 to 7.5 (centrals, obstructives and hypopneas remain in about the same mix).  Subjective sleep quality remains basically the same with several awakenings during the night. (This is the same pattern I experienced before APAP so its not a real surprise to me.)  Each night has one or two sessions with very low AHI's and one with higher AHI's. In addition to raising the pressure by .5, I also decreased the AFLEX setting from 3 to 1, and I don't know what effect that may have had; it is not uncomfortable.  All other measurements seem about the same to me.  Perhaps I am just simply too impatient, but I notice others get rathers quick changes, either positive or negative, with a "tweak" to settings.  I need your advice: continue with pressure at 7.5 or drop back to 7.0?  What effect can AFLEX have, it doesn't seem to be a comfort issue either way.  How long should I stay at a new setting to expect a pattern change.  Again, the increase in AHI seems to be an isssue to me; but perhaps it is not.  Perhaps an increase in pressure takes time to affect the AHI.  In addition to the PDF summary, I have included two nights, last night at 7.5 and the last night at 7.0 (January 30) .

I appreciate your advice.  BTW, the PDF post will have to be rotated to read it.  The control is on the Adobe screen.

Last Night (February 3):



January 30:

  

[Sleeprider]

First observation is that the maximum pressure has not affected any of these results. The difference between a minimum pressure of 7.0 and 7.5 is statistically insignificant from my visual review of results. There is variation with either pressure, and nothing stands out as particularly better or worse. In all cases so far, AHI is acceptable, and events are mainly hypopnea. In general, your auto machine changes very very little regardless of the settings. To really pin down what works best, you might use single pressure therapy, i.e. 7.0 7.5, 8.0 etc.

Another variable to try may be to try different Flex settings and see if it makes a difference. What version of Flex are you currently using? I think the number of events will eventually decline as you become more accustomed to the therapy.

[RWhipkey]

Sleeprider

Thanks for your advice.  I'm using A-Flex (enabled by the DME), setting at 1 now (based on Newbee2016's experience as posted above); started at 3.  Is that ok?  I know Resperonics has C-flex as well, but I'm not sure that my machine can be set to that option.  I agree that pressure results on auto differ little between 7.0 and 7.5.  But the AHI was lower on 7.0; although the data is over short periods in the first month of therapy.  Why do you think that was so?  I feel like I'm jumping around too much and I need to be more patient. Your statement "I think the number of events will eventually decline as you become more accustomed to the therapy" is encouraging.  Rather than go to a fixed pressure now perhaps I need to give an auto setting a longer look.  Would you advise 7.0, 7.5 or even 8.0 for a longer test?  Would you advise A-Flex of 3, 2, 1 or none?  I have maximum pressure at 11.0; that seems ok because I'm not bumping up against it.  How long should we agree on the test? Should I respond to this thread earlier if results either dramatically improve or even deteriorate?    Lastly, my machine has Optistart technology.  I turned it off (DME enabled it) after I increased minimum pressure to 7.5. Should I use it; I'm not sure exactly what it does.  Promo literature says that, "With Opti-Start enabled, the machine begins therapy at 90% of the pressure reached in the previous session to help address residual events that may occur early in therapy."  I'm not using Ramp.  I don't feel I need it to fall asleep and I think it just allows the machine to fall to even a lower pressure.  Your experience is invaluable to help me settle on a plan; thanks Sleeprider for all that you have done.