Free CPAP Advice and Sleep Apnea Treatment Help Board • View topic - Should I do anything differently?
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BodhiM
  Unread post  Post subject: Should I do anything differently?  |  Posted: Sat Dec 15, 2018 7:58 pm
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Hi There

I have using CPAP therapy for 15 months now. I went though the aerophagia, skin rashes etc and resolved these. I also managed to find a mask that suits me.

I went back to see my Sleep Physician and I find him to be really thorough, however I find his Tech incredibly frustrating as her focus is on seeing an AHI under 5. She is even happy with seeing an AHI of 4.9 as long as its under 5. She also wants me to leave the pressure range from 4-20. I won't be doing this!

I have attached two samples of a typical night for me. Would you recommend doing anything differently? My OSA is predominantly REM based based on my PSG. Most apnoeas registered look like the sample I have attached. A big spike before the apnoea.

Thank you in advance.


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Pugsy
Unread post  Post subject: Re: Should I do anything differently?  |  Posted: Sat Dec 15, 2018 9:30 pm
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Joined: Wed Aug 02, 2017 8:01 pm
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You might want to watch these videos
http://freecpapadvice.com/sleepyhead-free-software

IMHO 4 min and max 20 will be a recipe for disaster...I wouldn't be doing it either.

Any special reason for the extremely tight auto range?


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diamaunt
Unread post  Post subject: Re: Should I do anything differently?  |  Posted: Sat Dec 15, 2018 9:56 pm
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It's not bad the way it is, your obstructive apnea/hypopnea is under one, and that's good (4.9, it should be obvious, isn't).

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BodhiM
Unread post  Post subject: Re: Should I do anything differently?  |  Posted: Sat Dec 15, 2018 11:17 pm
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No real reason for the right range other than feeling comfortable with it. Anything less than 11.5 feels like I can’t breathe and I noticed and I get lots of leaks and squeaks at 14 and above.

I won’t open up the range as suggested by the Tech. I agree it’s a recipe for disaster. I have no idea for her reasoning. I can only guess that it is because she could see the AHI was under 5 right from the start at that open range. It’s very obvious to me that the aim is to be under five and that is the definition of being
successfully treated . She kept repeating ‘we want to see you under 5, that’s the main thing’. There was no consideration for optimised treatment.

I will watch the video you recommended.

I’m very happy with the dream station and I am considering buying a travel machine. At the moment, only the Resmed is available.


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diamaunt
Unread post  Post subject: Re: Should I do anything differently?  |  Posted: Sun Dec 16, 2018 1:03 am
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"under 2" is actually pretty good, "under 5" is pretty bad.

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BodhiM
Unread post  Post subject: Re: Should I do anything differently?  |  Posted: Sun Dec 16, 2018 2:23 am
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agree- I am going to mention this to my doctor and see what he says. I am going to skip seeing the Tech at my next annual appointment.

We are very luck here in Australia, we can buy any kind of PAP machine we like and we don’t need a prescription for it. We can buy a Machine even if we ‘just’ have UARS or an AHI under 5. My insurance paid for 75% of the machine so I feel it’s a shame that some people will be missing out on optimised treatment is the goal is just to have an AHI under 5. It’s not the full picture.

Thanks for your help.


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Pugsy
Unread post  Post subject: Re: Should I do anything differently?  |  Posted: Sun Dec 16, 2018 5:30 am
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A lot of people who sell this stuff don't actually fully understand how it works. They think "oh, the machine is an auto and it can do all the adjusting straight away...set it wide open and forget it and let the machine sort it out"...kind of thinking.

And for some people with pressure needs of 5 to maybe 9 or 10...might work out just fine.
Doesn't work out so great for people with pressure needs in the higher numbers. Simply takes too long to get from 4 to 12 or wherever and the airway closes up and even opens back up long before the machine has come close to where it needs to be to hold the airway open and prevent the collapse.

This is why the minimum setting is so important. The machine can't from from 4 to 12 in the blink of an eye. Some people just don't understand that fact.

Your reasoning for running a tight range is a sound reasoning. You understand what you need to do to limit your problems. That's fine.
I was just curious. Most of the time people do have a sound reason for tight ranges and nothing wrong with it as long as they are happy and getting good results.

That big gulp of air before a flagged event...that usually points to some sort of arousal from sleep. Might mean that the flagged event isn't real because you weren't sound asleep when it happened.


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BodhiM
Unread post  Post subject: Re: Should I do anything differently?  |  Posted: Sun Dec 16, 2018 7:13 am
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Thanks Pugsy.


Thinking back to the first month of use, I think I used the 90 percent pressure value to determine what the lowest pressure should be. It just made more sense to be to set it there so there was no need for the machine to ramp up. I was using the Resmed AirSense for Her at the Time and I found the ramping up of the pressure would wake me up. I found the Resmed machine a little too aggressive for me as a newbie so went with the DreamsTation instead.

Thank you all for your help.


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diamaunt
Unread post  Post subject: Re: Should I do anything differently?  |  Posted: Sun Dec 16, 2018 2:23 pm
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Pugsy wrote:
Doesn't work out so great for people with pressure needs in the higher numbers. Simply takes too long to get from 4 to 12 or wherever and the airway closes up and even opens back up long before the machine has come close to where it needs to be to hold the airway open and prevent the collapse.

The worse part about why setting the min pressure too low is really terrible...

The machine spends the entire night trying to get back down to that minimum pressure, which causes a continuous roller coaster of events/pressure rise, pressure fall, events/pressure rise... all night long.

Suggesting going to factory defaults like that sleep tech is doing, should be a capital offense. I wouldn't pay attention to ANYTHING she says.

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diamaunt
Unread post  Post subject: Re: Should I do anything differently?  |  Posted: Sun Dec 16, 2018 2:27 pm
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Joined: Wed Mar 02, 2016 2:26 am
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Location: Dallas(ish)
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BodhiM wrote:
Thanks Pugsy.


Thinking back to the first month of use, I think I used the 90 percent pressure value to determine what the lowest pressure should be. It just made more sense to be to set it there so there was no need for the machine to ramp up. I was using the Resmed AirSense for Her at the Time and I found the ramping up of the pressure would wake me up. I found the Resmed machine a little too aggressive for me as a newbie so went with the DreamsTation instead.

Thank you all for your help.


Honestly, the 90% pressure is meaningless. You could have a situation where you spent the whole night at 7, except for a few minutes at 12... and your 90% pressure would be 12 or so.

Much better to evaluate the pressure line, trying to guess at what happened by a couple of statistical numbers....

Also, it's very likely that it was the *events* that caused the pressure to go up, not the pressure change itself that was waking you up. (that's a common misconception). Sleep apnea events wake us up... that's why we're on the machine in the first place.

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mbushnoe
Unread post  Post subject: Re: Should I do anything differently?  |  Posted: Fri Dec 28, 2018 5:02 am

Joined: Sat Aug 11, 2018 12:15 am
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She is probably too in her own head about the ranges used for titration.

For a titration study, its technically considered "optimal" when the AHI is < 5, and at least 15 minutes of REM sleep is recorded in the supine position.

That is by the book, but obviously you want to get your AHI as low as you possibly can, especially if you feel better sub-1 than you do sub-5. If you were to jump over 5, youd technically have mild apnea.


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