Brand new to board... a few questions before I get my CPAP

[Pugsy]

Does any part of that readout or software indicate whether I am sleeping or not?

Are you talking about the report from your PR S1?
No..the machine can't definitively document sleep stages but I assume that you slept at least part of the night last night.

Could you do something for me.
Zoom in on a time frame where there are 2 to 4 centrals within a short time frame that show up on the same image?
Like 00:30 or 1:00 if you think you were asleep by that time.
Here's the level of zoom I would like to see
Click on the events tab...then click on the Clear Airway category...the look in the list for a time where the events are close together in a short time span.
Click on the event that is sort of in the middle...that way you maybe have a couple of events on either side of it.
The graphs will automatically zoom in so you can see the flow rate zoomed in up close. It's this level of zooming in that is helpful to maybe get an idea if we are seeing SWJ (Sleep/Wake/Junk) or the real deal event getting flagged.
Grab a screen shot of the zoomed in section and include the top events graph along with flow rate graph.

[yaconsult]

When you have multiple periods of use on a graph, you can easily display only some of them when you want to take your screenshots. If you look in the left hand column under the pie chart and scroll all the way to the bottom you will see the Session Information. You can click on the different sections and this switches them on and off in the main display. By using this method, you can remove sessions recorded when you were still awake and watching tv or whatever.

Oh, and even better, it removes the unselected data from the calculation of the AHI value so that you get a more accurate number. Lots of false events get recorded when we are awake but using cpap because, unfortunately, the machine has no way of knowing that we are not asleep.

This session enable/disable is a great feature of sleepyhead that I think many people may not realize is there or take advantage of - it doesn't exactly jump out at you. I use it a lot since I will wear my mask if I'm watching netflix in bed. The other trick I use is to turn the machine off for a second and then back on again (since I do not use a ramp) to mark the time when I stopped watching something and went to sleep. This leaves a small gap in the data that is easy to spot and makes it a separate session that you can not display when you want to take a screenshot for posting.

[hifiaudio]

Pugsy here is what you were asking for I think...



And thanks for the tip Yaconsult... here is my overall data again with the unnecessary sessions removed...





I just went and got a chinstrap so I should be ready for tonight. The lady at the medical supply store said that insurance pays for two types of masks in the first 30 days so she said I could go ahead and get a full face to go along with my Swift FX pillow if I wanted.

[Pugsy]

Yes, thank you. That was what I was asking for and I was looking for a pattern and I don't see the pattern (and that's good that I don' see it).

For right now...just concentrate on using the machine and getting the sleep. You may or may not need a different machine but this one needs to be used right now and cross that other bridge later once you get some for sure blocks of sleep documented and we see what is happening on the reports.

[Nyre]

I have had my sleep study, but not the follow up visit to discuss and get my machine, which will occur this coming Monday. The study technician was nice enough to answer a few of my questions and give me a little info. I have both central and OSA. I am 37, 185lbs, male. I am not sure how many events I had, but the central apneas kept me from breathing for up to 70 seconds at times. My O2 desaturations we into the high 50s.

When the lady called today she told me I will be getting a CPAP at a pressure of 13. During titration I did find it hard to exhale with the mask on.

My first real question is "Is there any reason NOT to get Apap now?" Aren't they pretty much state of the art for the technology? Why would I want something that cannot auto negotiate an appropriate pressure at all times? Are there disadvantages?

Or is this often a matter of what insurance will pay for? Am I free to ask for a more expensive or better machine and have insurance pay whatever they were going to for the cheaper machine? Or is that worth it or something I should even pursue?

I don't really know how much of this is my doctor or, worse, insurance company giving me what they want to vs what is truly best for my comfort and long term use of the device.

I also was diagnosed with Central Sleep Apnea and my Doctor ordered an Auto Servo Ventilator(ASV) for my Centrals and OSA. You may want to talk to the Doctor about having a Titration study done on an ASV Machine My insurance paid for the ASV skipping over a regular CPAP. I currently Have Humana Medical Advantage Plan and Indiana Medicaid as my insurances. You should be concerned about those Centrals especially if they are happening frequently enough that a CPAP wouldn't suffice for your treatment.

[hifiaudio]

So I had another phone conversation this afternoon with my mask tech. She is also the person that goes through every line of the sleep studies for the Dr. to give him the summary, document all abnormalities, etc.

She said that there was a very long discussion at their office after my study and they concluded that I did very well at the end of the titration on the final pressure (13) and that both types of apneas went away. So that is why I am on CPAP for now. She said we will all be monitoring any centrals once I start getting real sleep and see if there is cause for a different machine.

[Pugsy]

Okay...they are aware of the potential issue with the centrals and are monitoring things. That's the best we can do for right now.
Your main job right now is just figure out the mask and leaks and learning to sleep with the alien on your face and keeping your mouth shut. Give it some time so that you can adjust to the therapy in general and see what happens with their reasoning and ideas about the pressure of 13 resolving the issues.

Your machine reports total leaks which are the mask's intended vent rate plus any excess leak. Large leak territory for your machine at your pressure and your mask is going to be up around 80 to 90 L/min. SleepyHead will flag the time that you might be in large leak territory...that's the LL at the top of the events graph.
Up to large leak territory your machine will be able to do a good job compensating for leaks (no matter what the cause). Now of course if a leak (or mouth breathing) causes you to wake up, even if it is tiny, then it is unwanted because it is disturbing sleep.

[hifiaudio]

Ok here is an update for night two...

I got a chin strap and tightened it as much as I could stand. I was actually way more annoyed with the feel of the strap than I thought I would be. Made the sides of the mask dig in a bit more too since it was tightened over it. But I persevered. It didn't really help much, though. I still found a way to let air out of my mouth despite not really lowering my jaw. I guess I just released it out of my lips and lowered my tongue. So I don't really know what else to do for a nasal pillow. I really like the pillow much more than something over my nose, so perhaps I will try a hybrid mask next. What is a top recommendation for one of those?

I slept a little more last night since my wife put in earplugs and I believe I stayed asleep for decent amounts of time even though I was breathing out through my mouth and making the whooshing noise. I would wake myself up doing this after a while. My numbers are not good, though, although they are mostly OSA now instead of centrals. I assume that opening my mouth a lot could cause all of these obstructive ones....

I am also not sure that my humidifier is working. The machine SAYS its working, but after two nights on level 2, the water has BARELY receded from the original fill line from the first night. Barely at all. That can't be right, can it? Also when I took the humidifier out last night to look at it, the plate was not warm. It should be pretty warm at level 2, right?

Here are the stats:

[Pugsy]

You don't need to try to include the Resp rate and snores on the screen shots. The resp rate isn't particularly useful and snores are see on the events graph.

If you want to consider one of the hybrid masks I would suggest the Innomed/RespCare Hybrid as it comes with all sizes of cushions available (and it's cheaper if buying out of pocket).
The ResMed Liberty is also a hybrid but you have to decided ahead of time which size you need.

Chin straps aren't suppose to be like vise grips...they are supposed to be gentle reminders for the mouth to not drop open but they can't prevent mouth opening totally. I can clench my jaws shut but still open my lips and breathe through clenched teeth. Chin straps can't stop that sort of mouth opening. And they shouldn't be causing more issues than they are fixing.

[hifiaudio]

Ok I will check with the medical supplier near me to see if they have those for me to come in for a fit. Both seem adequate. The Mirage is way more expensive online.

I hope the store was right that I can get one nasal and one full face (I assume hybrid counts as full face) from insurance. My doctor's office said only one would be covered. I will just pay if I have to I guess.

[Pugsy]

A hybrid mask is considered a full face mask because it covers both the mouth and the nose in some fashion.
There appears to be a new sort of hybrid mask from Respironics coming out in the future that uses a nasal cradle instead of nasal pillows but unless your DME was part of the promo DMEs yours won't have one and it could be a few months before they make it available everywhere. It's still in the demo stage.

I have used the Innomed Hybrid. It's bitch to get put together and fitted but once it's done it's not a bad little mask.
I only used it one night though and that was to just see if I could do it. I was in tears though while getting it all put together and trying to get it fitted. Of course I was a newbie to therapy and thought that everyone telling me I would die a thousand deaths if I didn't have a full face mask available for when I might have a cold and couldn't use my nose...so I was sort of in a panic. I have long since learned that I won't die if I have a cold and use my nasal pillows. but my patience level still probably leaves something to be desired.

If you try a hybrid mask be sure and watch the fitting videos and give yourself LOTS of time to play around with the fitting so that you aren't under pressure right at bedtime.

I was able to retrain my mouth to stay shut (for the most part) and maybe with some time and experience your mouth will learn to stay shut. I also found the chin strap more annoying than it helped so I elected to just tape my mouth and did that for about 2 months and sort of started slacking off and "forgetting" to tape...and after about 2 months or so mouth opening wasn't an issue. My mouth opening was more of a habit from gasping for breaths due to sleep apnea events. Once those events stopped and there was no need for gasping...the mouth learned it could stay shut.
I hesitate to suggest taping to a 2 day cpap user I remember when I first read about people doing that and I thought "OMG no way in hell could I ever do that"...but I did and found out it wasn't so bad after all but I did a lot of things to alleviate my concerns before I did that. Should you ever want to visit mouth taping...let me know and I will share with you what I did to alleviate my concerns.

At this point in things....maybe a hybrid would be a suitable choice for now.

[hifiaudio]

Ok cool, thanks. I may give this one you mention a try...

https://www.cpap.com/productpage/RespCa ... atures-tab

I would be interested in reading a little about taping. I think that is my only other alternative unless I go to full face.

[Pugsy]

Tons of information about taping on the forum....pro and con
It's a personal choice.
You can start here with some reading.
viewtopic.php?t=8011

For me...this is what I did once I decided to try it.
First of all I experimented with the tape while awake and just playing with things. I experimented with just how much force it took to open the mouth in the event I just had to...and it doesn't take much force at all...a big yawn will do it.
I elected to use 2 inch blue painters tape because I am a tightwad and I had some handy and it didn't tear up my lips or skin.
I also experimented with breathing with my mask on and the machine off to see just how uncomfortable I got with only the air exchange from the vent holes....I got bored at 30 minutes and quit that experiment...never did get uncomfortable or suffocated feeling. It was a bit "tight" but not unbearable or really all that uncomfortable.

First night I taped...big thunderstorm and yep...we lost power in the middle of the night. I did wake up but in no distress breathing only through the vent holes...I woke up because of the silence...took me a few minutes to realize why it was so quiet (except for the thunder boomers). Stayed up for a short while until power came back on and went back to sleep (with my mouth taped).

FWIW...I also briefly tried the Polygrip thing...it works and it doesn't set up like cement but that stuff tastes downright nasty. and a bit of a mess to get off the lips in the AM.

[SleepDisturbed]

Ok cool, thanks. I may give this one you mention a try...

https://www.cpap.com/productpage/RespCa ... atures-tab

I would be interested in reading a little about taping. I think that is my only other alternative unless I go to full face.

I would suggest trying with the pillows a while longer. I notice a lot of newbies change things too quickly, not giving their brain and body any time at all to adapt.

The chin strap is a gentle reminder, not an iron maiden. Also, practice keeping your tongue at the roof of you mouth with the tip touching the roof just behind the upper teeth. Having your tongue in that spot will shut the door on pressure.

I always suggest that someone try a change for about a week before changing something else.

FFM have their own set of challenges, as does everything for us hose Heads!

[hifiaudio]

Looks like the local place wont have the hybrid until Friday anyway, so I will have to give it another couple of nights with the current pillows regardless. Yeah I am trying to keep the tongue up. I have no issue until I doze off, the the tongue falls I guess and wakes me right up with the whoosh.


Oh - what about my humidifier comments? Does it sound like it is not working?