Interpreting results

[sleepysteveo]

Hi Everyone,
I have had sleep apnea for over 20 years. Recently I started to be more proactive in trying to improve my quality of sleep. I figured out by downloading the clinicians manual how to take control of my S9. I have struggled with being compliant with this machine that I have had for a few years and am now starting to understand why. A typical nights sleep used to be an AHI of over 20. my machine was set up so that I could not see my nightly AHI.. it was only after I set it and could see how badly I was sleeping that I confirmed what I was feeling.. horrible sleep.
I also discovered that the EPR was only set to be active on ramp which I immediately changed. Whats the point of having a feature that you don't use! My r/x is for 15 and my machine is an autocpap and was set from 9-17 with a 45 minute ramp with EPR. I recently went in to the provider of the machine and the technician suggested based on the data that I remove the ramp completely if I can tolerate it as I get a significant amount of events as the ramp is coming to an end. Typically I have a large number of events each time I start or restart my CPAP if I have gone to the toilet. Now here is my first question, last night I had several central apnea events at the start of the night when I was still awake.. and I know this because I looked at my watch at the exact time these events were recorded.. and yes I have the clock set correctly, another thing I fixed!
I have been slowly adjusting my low end setting to see if I can reduce my events. Tonight I have set the low end for 12.4 and 17 is still the high end.I rarely touch the high end when on therapy. my EPR is set to 2 and I have removed the ramp.
Any thoughts would be great.. I have attached a screen capture to show you the graph for last night.[attachment=1769][attachment=1770]
Thanks in advance for any input
Steve

[DariaVader]

welcome to apneaboard sleepysteveo

CA is not necessarily a Central. It stands for Clear Airway and if you are awake, it is just the way we breathe sometimes when we are awake. The machine cannot truly detect a central, since it has no eeg. CA in machine terms just means you took overlong to inhale, but there was no obstruction detected.

The advice to turn off ramp is a good one. If you need it you can turn it back on easily, but I doubt that you need it. You may also try moving the bottom up a nother notch... and it looks like a leak woke you up.

[GingerMan512]

Ya after my first night I turned off ramp and set EPR to 2 with my ESON and 3 with my P10 pillows. My AHI average is less than two now typically. Untreated I was at 100+

I toyed with setting to APAP and it didn't make much of a difference so I set back to constant 11.

[PaulaO2]

Changes have to be made then left alone for at least ten to 14 days. A night or two isn't long enough to see if it is working or not.

[trish6hundred]

Hi sleepysteveo,
WELCOME! to the forum.!
It’s good to hear that you are taking charge of your Sleep Apnea.
You don’t have to have ramp turned on if you don’t want to, it’s a comfort feature, same with EPR.
Much success to you as you continue your CPAP therapy and hang in there for more responses to your post.

[sleepysteveo]

thanks for all the comments everyone. I will be patient and not change settings too often to see what happens.
Steve

[ginzo]

Unless I'm uncomfortable with a change I made, ie. EPR from 3 to 0, I changed it back after 1 night. I try to run a minimum 7 days, but generally try to get a 30-35 day average in before the next change.

For example, just recently, I switched my CPAP (35 days) from 14cm ( I had sever LL issues), to APAP pressure from 9-14 cm (35 days). At that point I was very close to where I needed to be, but noticed my apneas are around the 10cm mark.

So I just said "self" if your apneas are around 10 and your starting at 9, maybe a boost to 10 might catch them before they get started? So I set up for 10-14cm.

So the 1st couple of days my LL's shot back up some and apneas were still about the same, I thought maybe not so good and was ready to go back. Well after 6 DAYS SO FAR, I'm starting to move in the right direction. (keep in mind, I try to tough out 30 days).

My long winded point is exactly as some have stated, you have to "settle in" so to speak. I was ready to panic after day 2 but hung in there and now I'm on the way to my 30-35 days where I can get a true picture of what, if anything I might need to do next.

To be totally honest, I already have the mindset of moving back to say, 9.5-14cm. BUT let the data tell me that 1st.

Good Luck,
Chuck

[PaytonA]

Generally speaking, it blows my mind how many people seem to have a first thought of reducing the pressure when they encounter leaks. I must admit that when I was fairly new to PAPing, I had the same thought and even went to my PCP and asked him to write a scrip for a lower pressure. He said that he would rather send me for a titration which came back at the same pressure as the first. When I finally found this board and started learning about what was going on, I changed my mind and now lowering my pressure to avoid leaks is my last resort after trying different masks.

My feeling (opinion?) is that one should fix mask leaks at the mask and save pressure changes for other reasons. My therapeutic pressure is 20 cm/H2O and I have a mask that seals well. It took me a while to get there but I finally did and I know of a mask that reportedly is capable of sealing at 40 cm/H2O and does.

Even Paula finally found a FFM that works for her with all of the obstacles that she has.

I guess that my real message is not to make pressure changes the first effort to reduce mask leaks.

Hope I didn't sound too didactic. Did not mean to.

Best Regards,

PaytonA

[ginzo]

PaytonA,

As a newbie, I value ALL input. As many of you here are more trained/skilled than I. I'm here to learn. I, IN NO WAY take your post as an assault, or directed at me. Only as your valued opinion. I do see your point on rushing to reduce pressures.

BUT, since I've been here, I have asked many questions, been provided many answers, and have done much research on said Q & A's.

I, on my own, (with the direction of my CRT Sister) have made decisions to change pressures as a trial to solve certain problems.

A little history: I have been an apnea patient and CPAP user since 2007. It is since I made my 1st visit back to my apnea DR. to get a prescription to replace an older machine in June of 2015 did I realize I had a LL problem. He scanned my card, found the issue and pounded me with questions. Sleeping habit, rest, alcohol use, caffeine, quality of life etc. Even with unknown LL's, my therary has been a blessing. He was satisfied with my answers that all was well and left me on CPAP with a higher pressure than I had been using (14cm to 16cm).

It was then that I started to "own" my therapy and see what, if anything was amiss. Hence, here I am, thankfully so, as this forum, and its members, has improved my therapy a thousand fold. I thought I was doing well, and I was until I started looking for ways to improve my therapy. It was with careful consideration, and dully noted that I opted to make these changes. Everything was written in a log so I could "undue" any issues.

BTW, I was only fighting LL issues, not any kind of apneas etc. So it was just a single battle to try and better my leak issues. Everything else was well within parameters of healthy therapy.

Luckily for me, in my case, reducing pressure was a positive. (Does that sound right)?

Here are the results:
7/17: pressure 16cm (per MD)
7/20: pressure 14cm (per MD)
8/10: tried different mask seen some improvement.
8/11: started chinstrap w/P-10
8/23: went to APAP 9cm-14cm (on my own)
9/27: went to APAP 10cm-14cm (on my own)



Pressure Change Results

Regards,
Chuck

[PaytonA]

Actually my comments were truly meant to be in general. I probably should have started a new thread to avoid the appearance of the comments being aimed at ginzo.

I had the same situation as ginzo early in my therapy where I thought that I was getting good therapy but later learned that I had a major large leak problem. It took finding this forum and learning that there was data available and how to access it in order to find out that I had a large leak problem. After trying to teach myself to sleep with my mouth closed off from my airway and trying a number of chin straps, I finally moved to a FFM. It took some work to get everything working right with the FFM but now my leaks are generally under very good control. My median leak rate is 0 most of the time and my 95% leak rate is normally under 10.0 l/min.

Best Regards,

PaytonA