Last night really discouraged me - Need advice

[DonC]

  Apnea History.pdf (Size: 182.78 KB / Downloads: 92)

Hello again,
Please just take a look at the numbers on the spreadsheet. It shows the average of my Apneas with a FFM then with Large nasal pillows and then with medium nasal pillows (both Swift FX).
Just as a comment - the total Apneas number does not include the RERA total on Sleepyhead so I have kept it the same here.
I believed I was winning until last night when the numbers threw the average above the Large nasal pillows numbers. It is beginning to get to me. I keep hearing of people who are achieving numbers less than 1.0 (I didn't know if it was < or > sorry). How do I get there?
I enjoy using the medium pillows and would like to keep going with them as I think I have the leaks under control. I have 100% compliance throughout the use of all masks so you are seeing everything. My average usage is over 7.25 hours.
Please give me some help here, any advice will be gratefully received.
Don

[PoolQ]

If the leaks are under control with the medium pillows, then keep using them. They are not impacting your numbers.
The number of events are controlled by your pressure range, get us some graphs. We can't evaluate the pressure range without the graphs
Should you be able to get much lower numbers, yes
It's early in the game and your already done a lot.

[surferdude2]

I agree that graphs are needed to determine what's going on.

I will say that your large jumps in AHI are being caused by the inordinate number of CA's that are being flagged. Sometimes those can be ignored since they often occur when you are awake. The graphs may help determine that since they could show at what time the CA's occurred. In my own case, I ignore the first and last 30 minutes of a sleep session since I know pretty well that I'm awake at those times. I normally get a few CA's during those time periods.

Your progress look good. Things will settle down even more in time.

< means is less than
> means is more than
A good way to remember those two symbols is that the small side points to the small number or if you prefer, the large side points to the large number.

Dude

[Sleepster]

I believed I was winning until last night when the numbers threw the average above the Large nasal pillows numbers. It is beginning to get to me.

I take it from the other responses that you are new to CPAP. I see that your AHI is dominated by the CA index. I doubt any of this has anything to do with the choice of mask. It is normal for the CA index to be elevated like that at first, and then subside.

A look at your pressure graph might help shed some light.

I would not be discouraged. AHI is not as meaningful as you might think. There's no hard data on it. All we know is that we'd like to see it under 5 because that's the clinical threshold for diagnosis. Each event might be lasting just over the minimum of 10 seconds, and those count the same in the AHI as the really long and dangerous events that you can experience without CPAP therapy.

[DonC]

Thanks Guys,
It is a good job that people like you are on the forum. I certainly feel a bit more like putting the mask on tonight.
I have looked at the data and there certainly are a lot of occurrences where I stopped breathing for just over the 10 second threshold but there were a few where I achieved (the wrong word) OAs in the high twenties and even a couple of low thirties.
You can certainly see bunches of the CAs at the end of the graphs so I may have been awake but there are a lot are in the middle as well. Please look at the 11th, they are really spread out.
To give you the information you suggested I have attached a few nights graphs. In fact most of the nights with the medium size nasal pillows and, of course, the best and the worst performances in that period. They have both graphs that relate to pressure so I think they are the ones you want.

    [attachment=1859][attachment=1861]    

Thanks in advance,
Don

[PoolQ]

your starting pressure is low at 4 cm, I needed mine above 5.5 or I felt like I did not get enough air. If the 4 does not bother you then np, if it does up it some.

I don't have enough experience to comment on your pressure, others will chime in.

[Sleeprider]

Don, it usually doesn't make much difference, but try turning off EPR one night and see what you get.

[DonC]

Hi,
I have been advised to put up some 15 minute slots showing activity, flow rate, mask pressure, leak and snore so here are two. Please take a look at them for me and tell me what you think. The first is at three o-clock and I was definitely asleep and the second is later and I might have been waking up. I don't think so but I might have been.

[attachment=1867][attachment=1868]

I do remember after the first few days the technician at the supply company did turn the EPR on because I was having trouble with the pressure so now I am more used to it I am going to turn it off again. It is a quick fix if I struggle with it again. I am trying something new so I am really happy. Thanks Sleeprider.

I know I keep asking, but I want to try other things that will reduce AHI like change the humidifier (currently 4) but I don't know if I have to go up or down. Same with the hose temperature etc.. etc... Any tips welcome. Is there a list somewhere on the forum (if not there should be).

PoolQ - You have been one who offered advice to me, so please remember that you have way more experience than I have and I would love to hear from you (not everybody is responding). So - I am trying to get that message to everybody. Nearly all of you have more time with this than I have so don't think that you may not have enough experience, talk to me. I need your help.

Thanks again,
Don

[sonicboom]

Sometimes narrowing the pressure range between min and max pressures helps. Also, since higher pressures sometime cause CAs lowering the max pressure can reduce CAs.

[surferdude2]

My rule is: If your Ca's occur mostly while you're awake, don't miss a good chance to leave things alone for a while. For newbies, chasing CA's can be a fools errand. The same applies to the AHI index as a whole.

It's not like you're going to blindly probe around and hit the sweet spot in the early stages of therapy. It's more like you must wait until your body adjusts to the intrusion of this therapy before attempting to adjust the machine. In other words, first let your body adjust before you adjust the machine. Doing otherwise may cause you to zip right past the sweet spot without seeing it.

On the other hand, if you have CA's in great number while soundly sleeping, you should consult with your sleep doctor right away. You may very well need a different type of machine for your therapy.

Dude