Opinions on my CPAP data?

ssrssr · Post by **ssrssr** » Fri Apr 27, 2007 11:47 pm

Hi there everyone. I've been collecting CPAP data from my RemStar Pro M series for about a month and a half. I've also been using the very cool Encore Pro Analyzer program, to get more info about the data.

I'm still not feeling a fully rested as I was expecting/hoping to, and it's been five months since I started CPAP treatment.

I have my data posted at:
http://www.dodrill.us/EPro_Mar06-Apr26_2007.pdf
I would appreciate it if folks could take a look, and see if there is anything I should be adjusting.

Thanks, very much for your help.

bdp522 · Post by **bdp522** » Sat Apr 28, 2007 7:01 am

Welcome to the forum!

It looks to me like you have alot of leaks. You have to get the leaks under control. It also looks like your best pressure is 9.5. That is where you have the least events.
You are using a nasal mask. Are you mouth breathing? Your leak rate at a pressure of 12 should be about 37. If you are mouth breathing or leaking all the pressure is going out your mouth. Your snores are high also which could be caused by the leaks.

Brenda

NarcoApneac · Post by **NarcoApneac** » Sat Apr 28, 2007 4:50 pm

I'd try turning the C-Flex down or off. Myself, I get better therapy at a lower pressure with the C-Flex off. If you were titrated for straight CPAP at 12 cms and you are running with C-Flex at 2 most of the time, then you are not getting the prescribed therapy. It seems that many on this forum also do better without the C-Flex.

Additionally, if it were my therapy, I'd like to get more data at 9, 9.5, 10, ..., 11.5 cms. Since you've been at 12 cms, I'd try 11.5 for a while, and then 11, etc. as long as you continue to feel okay, and the snoring doesn't get ridiculous. It would be interesting to explore the pressure region where you were having no apneas. And you don't yet have enough data to see what is really going on in that region.

Doctors like to control snoring, because if you're still snoring your airway isn't entirely patent while sleeping. Some on the board here may ignore the snoring numbers, but with your relatively high level of residual snoring I wouldn't, neither would I assume that the machine is just "making up" your snore numbers - I doubt that your hose is generating "snores" all night long.

Good luck, and report back.

ssrssr · Post by **ssrssr** » Sat Apr 28, 2007 5:07 pm

bdp522 wrote: It looks to me like you have alot of leaks. You have to get the leaks under control. It also looks like your best pressure is 9.5. That is where you have the least events.
You are using a nasal mask. Are you mouth breathing? Your leak rate at a pressure of 12 should be about 37. If you are mouth breathing or leaking all the pressure is going out your mouth. Your snores are high also which could be caused by the leaks.
Brenda

Thanks for the reply. As far as I can tell, I have always had this amount of leakage. I don't have any leaks at the connection with the unit or in the line itself, I'm certain. It's been the same values for two hose/nasal pillow sets. When its up to the 12cm pressure, the air comes out the normal place at quite a fast rate, so maybe that's how it should be? I'm not sure.

I'm quite sure I'm not mouth breathing, because I will wake up instantly if my mouth opens at all. I've had this happen where my nose will get stuffy during the night, and I suddenly wake up.

ssrssr · Post by **ssrssr** » Sat Apr 28, 2007 5:15 pm

NarcoApneac wrote:I'd try turning the C-Flex down or off. Myself, I get better therapy at a lower pressure with the C-Flex off. If you were titrated for straight CPAP at 12 cms and you are running with C-Flex at 2 most of the time, then you are not getting the prescribed therapy. It seems that many on this forum also do better without the C-Flex.

Thanks for that info about "not getting the prescribed therapy". I still have a lot to learn, apparnetly.

My sleep study officially came up with 10 cms, and that's where I started 6 months ago when I first got the machine. Using the basic stats from the machine, my AHI went down when I upped the pressure from 10 to 12. But, now that I have the much more detailed stats, it sounds like its time to start at 10 again and get more data for several weeks.

I guess I need to learn more about what the different C-Flex settings actually do. If you have a quick link to a good summary, it would be appreciated. I'm happy to try a different setting--I just need to understand what is means to change it.

NarcoApneac · Post by **NarcoApneac** » Sat Apr 28, 2007 6:48 pm

Here is a link to Respironics own marketing explanation of C-Flex:

http://mseries.respironics.com/Technology.asp#CFlex

Some ResMed machines have EPR, exhalation pressure relief, which also provides a lower pressure against exhalation like C-Flex does, but EPR provides a constant exhalation pressure and then switches to a constant inhalation pressure. EPR acts quite like a bipap with the difference in inhalation and exhalation pressures limited to 3 cms. C-Flex, on the other hand, gives you some initial relief upon exhalation and then increases the pressure to the inhalation pressure before you're done exhaling.

In my informal experimentation at home, with a mask spliced into a manometer and gentle breathing while awake, it appears that with C-Flex at 2 with 10cms of pressure I get a very brief dip of about 2.5cms (down to 7.5cms) upon initiation of exhale, and then it runs the pressure back up to 10 before I finish exhaling.

The pressure that you exhale against is responsible for squashing apneas, while hypopneas and snoring are squashed by the inhalation pressure. So, you can see how a straight 10cms will give a different therapy than 10cms with a C-Flex of 2.

Goofproof · Post by **Goofproof** » Sat Apr 28, 2007 8:32 pm

ssrssr wrote:
NarcoApneac wrote:I'd try turning the C-Flex down or off. Myself, I get better therapy at a lower pressure with the C-Flex off. If you were titrated for straight CPAP at 12 cms and you are running with C-Flex at 2 most of the time, then you are not getting the prescribed therapy. It seems that many on this forum also do better without the C-Flex.
Thanks for that info about "not getting the prescribed therapy". I still have a lot to learn, apparnetly.

My sleep study officially came up with 10 cms, and that's where I started 6 months ago when I first got the machine. Using the basic stats from the machine, my AHI went down when I upped the pressure from 10 to 12. But, now that I have the much more detailed stats, it sounds like its time to start at 10 again and get more data for several weeks.

I guess I need to learn more about what the different C-Flex settings actually do. If you have a quick link to a good summary, it would be appreciated. I'm happy to try a different setting--I just need to understand what is means to change it.

C Flex is a comfort setting , it has almost nothing to do with you getting your treatment correctly. Mouthleaking, however does, you can not get your treatment correct until you get the leaks under control, and clearly they are not. When you sleep you can't always tell if you mouthbreath, as when you wake, you stop mouthbreathing. The only way to tell is to tape, glue or use a FF mask. Then, you can tell by the software whats going on. I find the Encore Pro charts, more helpful in finding problems because you see what's going on in the same vertical timeframe, The Encore Pro Analyzer, software is nice and I like how it shoes up the number of apnea events and how long they lasted, very important to know. Jim

NarcoApneac · Post by **NarcoApneac** » Sat Apr 28, 2007 11:26 pm

C Flex is a comfort setting , it has almost nothing to do with you getting your treatment correctly.

This statement certainly isn't true for me, but maybe C-Flex doesn't make a difference in your therapy, Goofproof, and I believe that could be true.

For me it is very clear that my best pressure with C-Flex on is higher than with it off, and the therapy isn't as good. Many people on this forum have suggested that they do better with C-Flex off. The original poster only showed data with C-Flex in use, and I think that shutting C-Flex off for a while is certainly worth a try for the original poster who was looking for suggestions.

DME_Guy · Post by **DME_Guy** » Sun Apr 29, 2007 12:18 am

C-flex shouldn't affect the therapy. It is for comfort only. It decreases the pressure when you begin to exhale and is supposed to back up to full pressure by the time you inhale. Having said that, everyone is different. There is rarely an answer that applies to every user.