Plmnb's Never Ending OSA Journey (Data)

[Plmnb]

Thank you SuperSleeper and Joeywallaby for your interest and kind words.  I wish I had known about online support like this 7 years ago when trying CPAP for the first time.  I probably would not have given up, or at least tried for longer.  I am determined that this time, I will find relief.  SuperSleeper, you are spot on about taking time to smell the roses.  I have been trying to follow through on going out for a walk around my subdivision every day, I just never seem to accomplish it.  I wanted to go last night with my husband, after dinner, but I fell asleep very early...around 9pm ish I think.  I will try again this week.

Sigh.  Down to business now.  So, I initially went to sleep much earlier than I normally do.  I set my CPAP back to EPR 3 from 0.  (Was at 0/off for one night due to cervical collar experiment).  I also decided to see what happens if I went up on maximum pressure, to 16. Evidence has been showing that I have been nearing the previous max pressure of 15 very much of the time.  At some point during my nightly awakenings I noticed my pressure was at way over 15.  I wonder why? 

Upon viewing last night's charts I noticed that my RERA number is the highest I have had yet since starting these recordings, 4.51...nearly 1/2 of my event breakdown. Previously, my highest number was 4.31 on the 13th of Dec.  I wonder why?    

I also have a question about my snoring.  What is the significance of the data about snoring?  Other than it being extremely annoying to our significant others, and a symptom of OSA, why is this chart requested to be included in our chart postings?  

On these notes, below please find my charts from last night:  (As instructed, I removed the calendar and the pie chart...the second image is the continuation of the information that appears in that area.)


[attachment=18148]



[attachment=18149]

[Osiris357]

This is just a thought for those that are helping with settings. 

Wouldn’t a higher minimum like 10 or 11 stop most of that before it had a chance to start? Or would that have an opposite effect and increase the hypopneas and RERA’s?

This is what I did for myself that’s why I’m curious.

[ApneaQuestions]

....I also have a question about my snoring.  What is the significance of the data about snoring? ....

Here is a snippet from the Clinician's manual for the Autoset machine..

AutoSet mode

The treatment pressure required by the patient may vary due to changes in sleep state, body
position and airway resistance. In AutoSet mode, the device provides only that amount of pressure
required to maintain upper airway patency.

The device analyzes the state of the patient’s upper airway on a breath-by-breath basis and delivers
pressure within the allowed range according to the degree of obstruction. The AutoSet algorithm
adjusts treatment pressure as a function of three parameters: inspiratory flow limitation, snore, and
apnea.

I have not seen the machine respond to snoring in my case.... but if it can do so... I'd want to see that data to help me see why the pressures might be increasing.
Maybe that's why?
Personally, I'd prefer it if the triggering algorithms were made public and/or if the machine sent out an "event" saying "Pressure increased because XYZ detected". It would make it easier to interpret what's happening and why it's happening. Just a thought. I guess they don't want to reveal too much information otherwise a competitor could make a "clone" machine for 30% of the cost.

[Osiris357]

I have not seen the machine respond to snoring in my case

The chart for snoring my be your hose rubbing up against your nightstand or bed. Or the snore may not have been loud enough. I’ve noticed the same thing. It will respond to snores but only if they are loud enough I’ve noticed. Not me per say but my girlfriend has noticed that when they are gentle snores it doesn’t respond but if I let out a freight train snore then she hears the machine ramp up.

[Plmnb]

Wouldn't it be amazing to have a machine that could tell us such information!  Then of course some people might be put out of a job.

Another reason I was curious about the snore chart is because although I am only a 5'2 3/4 inch tall female I apparently have the snore of a lumberjack.  (I do realize that weight can be a big factor in OSA, and I am overweight...214 or so, however I had OSA even when I weighed 127.  I was originally told that a big degree of my problem had to do with the structure of my throat, sinus, etc.  Plus my father has always had OSA symptoms as well and it is known that OSA can be inherited.)

The sleep tech at my latest study said my snoring was so loud that she could have heard me from her home.   . And the last time I visited my family they told me they could not believe how loud I snored.  (They also told me that all the other noises I made, such as gasping for air and also stopping breathing had them ready to call 911.)

I look forward to hearing the observations on this mornings charts.

[OpalRose]

I think if you move your minimum pressure closer to what your median pressure reads, you may find that it will help with snores and actually tackle some of those events.  I also would leave the EPR at 3 as long as it doesn’t trigger clear airway events.  

Why is the minimum set at 8cm?  Look at your graphs and you can see how Flow Limitations and Snores cause the pressure to rise, often to whatever max you have set.  

If your pressure needs are high, which is what it appears, and causes you discomfort and sleep disruptions, the higher pressure needs alone should convince your doc to consider BiLevel.

I know, I too have a Doctor that doesn’t see beyond total AHI.  They don’t look at FL, Snores, Rera’s, etc.  I’m in the process of self financing a VAuto and hope to have one soon.  I will document the results from my current machine to the improved results (I hope) from the BiLevel and hope he takes me serious when it’s time to get another machine.  I won’t see him until next April, so I have some time to get my ducks in order.  You need to do the same.

[Sleeprider]

Something we have not tried is a maximum pressure of 20. I think Bonjour has mentioned that high pressure needs are a consideration for approval of bipap. It would be useful to see if you tolerate the higher pressures without discomfort, and to see if we can achieve the upper airway patency that we have been trying to achieve. It's certainly up to you. I recommend you try changing maximum pressure to 20 and see where that takes us.

[Osiris357]

Sleeprider for my own knowledge why not raise minimum pressure to try and stop them before they start instead of raising maximum? 

I know for myself raising the minimum enabled me to lower my maximum.

[ApneaQuestions]

Wouldn't it be amazing to have a machine that could tell us such information!  Then of course some people might be put out of a job.

I just made a post on my thread that may help remove some of the mystery for you.
The machine isn't telling you this information directly.. but you can figure it out easily.
http://www.apneaboard.com/forums/Thread-...#pid324414

[Gideon]

One of the things we do is take clues from that the CPAP is telling us. Here it is telling us to add more EPR or PS. That is maxed out (3) so we can't do that. The obvious solution is a BiLevel. So the current task, IN THIS CASE, is to qualify for a BiLevel to get the extra Pressure Support that the flow limitations call for. Higher pressures, over 15. are one of the considerations the medical community looks for. We know they generally, and in our opinion, discount flow limitations / UARS because they do not quantify very well. When was the last time that you even saw Flow Limitations mentioned in a Sleep Study? The number one criteria for qualifying for a BiLevel is to fail CPAP, requiring a High Pressure (greater than 15) is another that shows a CPAP is not working and is actually in titration guides as consideration for BiLevel.

In this case another of the things the CPAP is telling us is that it needs MORE pressure because it has maxed out. There ARE obstructive events at the max pressure which generally indicated the need for more pressure, in this case max. We like to keep the min pressure as low a reasonable because this tends to reduce aerophagia. Once more stable I would look at increasing the min pressure.