Data Analysis

[brownrabbit34]

Need help for analysis (used cpap 12 days across a month's span so far)

[LindanHotAir]

If you post a redacted copy of your sleep study report, you should get some useful suggestions for improving your treatment.

[staceyburke]

Welcome to the board, there are many people here that are quite knowledgeable and can help.  You did a nice job on the charts in oscar.  I do have several suggestion that will help.

first if possible turn off the ramp.  During ramp you are NOT getting any therapy.  On the night of the 23 you had one start and 3 times you restarted for a total of 4 periods of time in a 7 hr night sleep.  

Next take a look at your flow limit chart - you have a large amount of flow limits and they are apnea but not counted in the AHI!  They can cause loss sleep and stopping you from getting into deep sleep.  We try to fix those with EPR and you have EPR set at 3.  BUT it is not working because of other settings.

To explain EPR is exhale pressure relief.  Which means that it subtracts from the min to give you a lower exhale.  The problem being 4 is as low as the pap machine can possible go.  Your setting is min 5 EPR 3 so you exhale should be 1 but it can not be lower that the machine can go which is 4.  To make this work correctly you need to raise the min to 7 leave the EPR at3 (7-3=4...) 

another benefit is the Resmed moves pressure up when you have flow limits.  With the min 4 and EPR 3 you will have flow limits and in turn your pressure will not go up as high.  This may also help you sleep longer before waking up.

That leave your ca events.  And that is why someone asked to see your sleep studies.  IF you had CAs then it will be very hard with the machine you have to stop them.  If you did not have many CAs then they would be treatment emergent and most of the time they go away as your body gets use to the therapy.  So do post your sleep study redacted of any personal information.

From what you wrote you really need to work on using your cpap everyday, it is the only way your body gets use to the therapy and you will get better.

[Melman]

Stacey misread your data. EPR is off. Use of EPR will reduce your flow limitations but also may increase your central events. I agree you should eliminate ramp and increase minimum pressure to nine which will minimize pressure swings and may reduce CA. Try EPR of 2 and report back with data after making the changes.

[Dormeo]

Agreed re turning ramp off. The new minimum of 9 that Melman recommends will probably be comfortable, given that your median pressure is now higher than that. Try 9 during the day or evening to see how you like it. If you find it disconcerting, you can start with a minimum of 7 and sneak up on 9. But I think it'll be fine.

I think you will really like EPR, and starting with 2 makes sense. I see that you thought of trying EPR of 3. Nothing wrong with that, though you might want to raise the minimum to 10 if you jump in with EPR of 3.

For 1/24, the left panel says ramp is off and EPR of 3 is on, but the graphs looks like ramp is still on and EPR is off. Could you double-check your settings once you have changed them? (I think maybe what happened is that you changed your settings toward the end of the night. Is that correct?)

About flow limitations. Although they aren't apneas or hypopneas, they are significant disorders of sleep breathing. What is happening is that there are small restrictions in your airway that make it difficult for you to inhale smoothly. That means you expend extra effort trying to inhale, which can be disruptive to sleep. EPR drops you pressure when you exhale; by the same token, it increases your pressure when you inhale. That extra boost supports your inhalation effort and can make inhaling easier.

If the limitation is in your nose, however, EPR won't help. It works best for limitations in your pharynx, where the tissues lining the airway can sag a little during sleep.

So it's worth asking whether you think your nasal passages are restricting you when you inhale. Any thoughts about that?

[brownrabbit34]

Yea I did turn on EPR to 3 after the night of the 23rd

Doctor says I have a bit of nasal inflammation (not serious to them), and I think it's been chronic since childhood. Maybe allergies? I do notice difficulties with breathing like feeling I am not getting enough air and having to try harder (with nose, I always nose breathe) or especially when running but another doctor said this was likely anxiety.

[Dormeo]

Don't you get tired of "Given your anxiety..."? It's like what I get: "Well, at your age...."

OK, so I recommend a minimum pressure of 10 with EPR of 3 and ramp off. Please post a chart reflecting these settings. We'll all be curious how it goes.

I also recommend starting Flonase to see whether that helps a bit with the nasal inflammation. You might also consider asking for a referral to an allergist. When I did that, I explained that having congestion and postnasal drip made it difficult for me to use my PAP machine. That seemed to make sense to both my PCP and then the allergist.

[brownrabbit34]

Sure I forgot to record the 25th (with the others' recommendations of EPR 2, ramp off, min 9) and was too tired for the 26th

[brownrabbit34]

Ok I finally recorded some data. Flow limits seem to have gone down but not completely treated. Will prob ask sleep doctor for sleep study (when talking about results he only mentioned obstructive SA) and go to an allergist at some later point in time.

[Dormeo]

Yes, the flow limitations are much improved, plus the pressure line is smoother. But you still have CAs to contend with.

Please get a copy of your sleep study so you can see whether you had CAs then. You have a legal right to see it, and if you're persistent, I think they'll give it to you.

The CAs you're having now may be "treatment-emergent," meaning that they are a reaction to the PAP. If that's what they are, they may start to decrease on their own. They way to reduce them is usually to reduce or eliminate EPR, but in your case, the improvement in FLs is dramatic enough that I wouldn't recommend going that route. You could experiment with EPR of 2 to see how that goes.

They may also reflect poor sleep. If you are having a lot of mini-arousals, the deeper breathing you do as you fully or partially wake up may be followed by a pause between breaths of 10 seconds or more, and there you are with a CA.

Then again, you may have had a significant component of CAs in your sleep study results. That would suggest you may need a different kind of machine to treat your apnea.

Don't let your doctor tell you that CAs don't matter. Many of them say that, and I think it just means they don't know what to do about CAs.