SleepyHead shows AHI spike about the same time every night

[ISnoreBadly]

I've got 10 days on the CPAP under my belt and have been looking at the SleepyHead data. It shows that around 1:30 AM every day the AHI spikes from just about 0 to 8 or 9 and stays high for a few hours and then steadily decreases until it's near 0 again by the time I wake up.

I'm still having some issues with the pillows staying on all through the night, my wife keeps telling me that it's either off my face altogether and blowing at her or it's come out of my nostrils and is making noise. I don't know if the AHI spike correlates to those times, how would I see that data in SleepyHead?

I can post some SleepyHead screen shots if somebody gives me an idea of which graphs or sections would be useful.

[Sleeprider]

How long have you used your machine? It sounds like you are having apnea related to a particular sleep stage like REM. This is a perfect example of where an Auto works great. You can put your 460 into temporary auto titration mode using the clinical menu. It will stay in auto mode up to 30 days, then reset the CPAP pressure. I might suggest bringing this to your doctor's attention and asking for a change to auto cpap (DS560). That way, you can keep the lower pressure from your CPAP most of the night, and as the machine detects flow limitation from REM sleep or a change in body position, it will increase pressure as long as necessary, then resume the lower pressure. This is a perfect argument for your doctor to specify APAP in your prescription.

The alternative is to increase your pressure by 1.0 CM until the apnea spikes are treated. Since you are already at 12, I think an auto would be more comfortable most of the time. This can be solved with your current machine, but it might be a good opportunity to upgrade.

[ISnoreBadly]

How long have you used your machine? It sounds like you are having apnea related to a particular sleep stage like REM. This is a perfect example of where an Auto works great. You can put your 460 into temporary auto titration mode using the clinical menu. It will stay in auto mode up to 30 days, then reset the CPAP pressure. I might suggest bringing this to your doctor's attention and asking for a change to auto cpap (DS560). That way, you can keep the lower pressure from your CPAP most of the night, and as the machine detects flow limitation from REM sleep or a change in body position, it will increase pressure as long as necessary, then resume the lower pressure. This is a perfect argument for your doctor to specify APAP in your prescription.

The alternative is to increase your pressure by 1.0 CM until the apnea spikes are treated. Since you are already at 12, I think an auto would be more comfortable most of the time. This can be solved with your current machine, but it might be a good opportunity to upgrade.

I've only been using it for 10 days. If I set it to auto mode will that affect the compliance data at all? My insurance company is renting the machine for the first few months until they're sure I'm using it and then they buy it.

Can I set it to auto mode for a day or two and see if that makes a difference and then set it back to CPAP mode?

[TyroneShoes]

Actually, during major leaks it is more difficult for the xPAP to even determine whether there are apneas or not, so AHI should paradoxically go down when there are leaks. The algorithm is dependent on a closed system where pressure can be measured. If there is a leak, that can't be accurate.

Sometimes events increase during REM, but that is a somewhat different pattern than what you are describing. It also may be positional.

[TyroneShoes]

...I've only been using it for 10 days. If I set it to auto mode will that affect the compliance data at all? ...

Can I set it to auto mode for a day or two and see if that makes a difference and then set it back to CPAP mode?

Compliance is based on hours of use only.

It is not a terrible idea to try APAP, but I would try a narrow range first, such as 10-14 or 11-13. What the machine does within that range might tell us something about what your fixed pressure should be.

Also, steady as she goes. If you make any change to the therapy, stick with that change for a couple of weeks. Trends are what is important; individual results for a night are not. Marathon, rather than a sprint.

The general consensus around here is that if your doc is ruffled by you making pressure changes (as long as they are sensible), then buh-bye, doc, time for a new one.

[ISnoreBadly]

...I've only been using it for 10 days. If I set it to auto mode will that affect the compliance data at all? ...

Can I set it to auto mode for a day or two and see if that makes a difference and then set it back to CPAP mode?

Compliance is based on hours of use only.

It is not a terrible idea to try APAP, but I would try a narrow range first, such as 10-14 or 11-13. What the machine does within that range might tell us something about what your fixed pressure should be.

Also, steady as she goes. If you make any change to the therapy, stick with that change for a couple of weeks. Trends are what is important; individual results for a night are not. Marathon, rather than a sprint.

The general consensus around here is that if your doc is ruffled by you making pressure changes (as long as they are sensible), then buh-bye, doc, time for a new one.

I'm not worried about the doctor complaining about it, I'm concerned about the insurance company looking at the data and saying "Nah, you messed with it to change what was prescribed, we're not gonna pay for it now". But if they're only getting the hours it was used then that's not a problem.

I agree that steady is the right way to go, I'm in this for the long haul. And that makes me think that sticking with CPAP for now might be the right thing to do as I've only been using it for 10 days and am still getting used to it.

Before I ever got this machine I asked the doctor and DME about getting an APAP instead of a CPAP, they both said that after 30 days they would review the data and if the situation warranted it the prescription could be changed and I could swap this machine for another.

[PaytonA]

Before I ever got this machine I asked the doctor and DME about getting an APAP instead of a CPAP, they both said that after 30 days they would review the data and if the situation warranted it the prescription could be changed and I could swap this machine for another.

If that is the case, it might be best to just keep doing what you are doing. I would also let your doc and DME know what is going on.

[ISnoreBadly]

Last night I had my lowest AHI yet - 1.65. But it still showed a spike, see the graph below. I'm pretty sure I was up at 1:30 for some reason as I remember looking at the clock. I don't remember waking up otherwise and my wife didn't say anything about hearing the whooshing from my mask so it stayed on all night.

Do these numbers look ok?

[quiescence at last]

no problem -

the chart you are looking at is really helpful in showing you which hours you are having the most events. if above 5, or even 10 or 15, it is not a big deal.

The average over the whole night is what is generally used in diagnosis and to gage the effectiveness of treatment. (and this chart does not give you that.)

your chart goes up one notch every time you have an event, and goes down exactly one hour after that event. The chart shows the events that occurred over the whole last hour. (since it was zero a 2:30 the last event was before 1:30. at 2:40 you had an event and another at 3:00, 3:40 the first event drops out, but then you have another event about 3:42)

I almost never look at this chart. it is much easier to see the things I want to see in the flow rate chart.

Good luck.

QAL

[ISnoreBadly]

your chart goes up one notch every time you have an event, and goes down exactly one hour after that event. The chart shows the events that occurred over the whole last hour. (since it was zero a 2:30 the last event was before 1:30. at 2:40 you had an event and another at 3:00, 3:40 the first event drops out, but then you have another event about 3:42)

Oh! That helps, I wasn't aware that it did that, I assumed that it was getting worse each time but instead it's cumulative?

I almost never look at this chart. it is much easier to see the things I want to see in the flow rate chart.

I looked at the flow rate chart but wasn't sure what it was telling me. Can you enlighten me a little?