Untreated SA may worsen . . . heart health & diabetes

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Arlene1963
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Re: Untreated SA may worsen . . . heart health & diabetes

Post by Arlene1963 » Fri Jun 16, 2017 4:51 pm

Hi DH ... I think part of the problem is half of the events showing on her AHI is made up of so called "centrals". I checked her data closely in SH, and the vast majority of her centrals are SWJ. I surmise that the DME who is overseeing this is afraid of increasing pressure because of the "central" component. Meanwhile, I think the real problem is that my acquaintance is having brief arousals due to obstructives, and all of the "centrals" occur after such events when she transitions between sleep and wake.

FWIW, here's an example of what her DME thinks is perfectly ok.

Image

Anyway, I will suggest to her that she post here to this forum. I'm pretty new to all of this myself and would prefer her to be advised by long time members here.

My point in all of this is that often the support folks get once they've been diagnosed is pretty crap (certainly here in this city) from a medical stand point, and I find this disgraceful.

"Compliance" is one thing, but optimal treatment quite another.

On another note, I bought a used CPAP machine this past weekend at a local garage sale from someone who had given up on CPAP after 3 months. I downloaded the data from the machine onto SH and it was another example of sub standard treatment. I couldn't believe how bad the data was.

Just how exactly is this treatment supposed to work in this context?
Last edited by Arlene1963 on Sun Jun 18, 2017 3:30 am, edited 3 times in total.

D.H.
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Re: Untreated SA may worsen . . . heart health & diabetes

Post by D.H. » Fri Jun 16, 2017 5:15 pm

To Arlene1963,

Thanks for replying. Since I don't have significant Central Events, I really am not too up on that. It's true that too high pressure can cause or worsen Central Events, so tread with care!

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palerider
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Re: Untreated SA may worsen . . . heart health & diabetes

Post by palerider » Fri Jun 16, 2017 6:10 pm

Arlene1963 wrote: The sleep specialist will only see her in a few months and in the meantime she is at the mercy of a 23 year old at the DME who tells her that all is just wonderful, that because she's using her CPAP for 8 hours per night or more not to worry about the numbers. And most esp, not to listen to other people who have OSA who try to influence her treatment. And NOT to read internet forums.

Any wonder why so many fail and research studies show such poor results?

I am going to suggest that she post here and figure out how to improve things. I hope she will.

Sorry for the rant but it makes me so sad that we have this incredible technology and patients are simply not empowered to take care of their own treatment. No wonder so many fall by the wayside.
you're spot on...

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Re: Untreated SA may worsen . . . heart health & diabetes

Post by palerider » Fri Jun 16, 2017 6:13 pm

Arlene1963 wrote:FWIW, here's an example of what her DME thinks is perfectly ok.
I'd go autoset mode, 8-12 (in deference to Pugsy's admirable caution, and re-evaluate.

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Arlene1963
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Re: Untreated SA may worsen . . . heart health & diabetes

Post by Arlene1963 » Sat Jun 17, 2017 4:44 am

palerider wrote: I'd go autoset mode, 8-12 (in deference to Pugsy's admirable caution, and re-evaluate.
Thanks Palerider. Yesterday I showed her how to get into the Clinical Menu, and will pass the setting you suggest on to her today.

Anyway, sorry to derail this thread by going a bit OT.

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Re: Untreated SA may worsen . . . heart health & diabetes

Post by D.H. » Sat Jun 17, 2017 8:19 am

Arlene1963,

Please keep us posted. Best to start a new thread.

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Re: Untreated SA may worsen . . . heart health & diabetes

Post by Pugsy » Sat Jun 17, 2017 8:37 am

palerider wrote: I'd go autoset mode, 8-12 (in deference to Pugsy's admirable caution, and re-evaluate.
With the presence of the centrals and since we don't know why they are there, I think that caution in this situation is an especially good idea.

Palerider knows what I am about to say but I will say it anyway for benefit of newbies who might be thinking "OMG centrals" and panic.

The centrals may be real and they might be post arousal centrals or SWJ brought on by the OAs seen causing arousals.
It's painfully obvious that the obstructive component of whatever sleep apnea is going on here is inadequately treated. Since we can only fix obstructive stuff with the machine used then all we can do is attempt to fix that is known to need fixing that is fixable with the machine one has.

If the centrals are post arousal centrals and the arousal is from the OA stuff....it's very possible that the centrals will decrease once the OA stuff is better prevented.

There's a lot we don't know from the one report posted. We don't know if the person spent a lot of time awake with the machine and mask on which of course is kinda important to know when looking at a report like this with so many centrals and PB flagging.

Without having more information to help formulate ideas then I think caution is a prudent choice here.
Let the machine try to kill the OA stuff and then re-evaluate things once the OAs are reduced or the machine at least tries to reduce them with more pressure and it will at least try when in auto mode.

The presence of centrals....since there is a potential logical fixable explanation for them then might as well see if something simple and easy will fix them.
We aren't ignoring the centrals...just keeping one eye on them while treating what is know to be needing treatment and fixable with the machine the person has.

Is it possible that complex sleep apnea is involved here...of course it is possible but it is also possible that the centrals aren't real and if they are indeed post arousal or SWJ centrals then fixing the cause for the arousal and/or hopefully improving sleep quality (less wake up time if the person isn't sleeping well) might be just the trick to reduce the central numbers.
Remember an occasional central (like random sleep onset central) isn't cause for alarm.
Fix what is fixable with the current machine and then see what might be left over...about all that can be done right now anyway.

Centrals aren't a cause for panic...some may or may not be real so that is a factor...and even if real there are ways to deal with them if they are numerous enough to present a problem or of a duration to present a problem. Cross that bridge if or when it needs to be crossed.
Try easy fix first...never know..might just get lucky and it quickly and easily fixes the problem.

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Re: Untreated SA may worsen . . . heart health & diabetes

Post by palerider » Sat Jun 17, 2017 10:53 am

Arlene1963 wrote:
palerider wrote: I'd go autoset mode, 8-12 (in deference to Pugsy's admirable caution, and re-evaluate.
Thanks Palerider. Yesterday I showed her how to get into the Clinical Menu, and will pass the setting you suggest on to her today.

Anyway, sorry to derail this thread by going a bit OT.
it's the best kind of derailment...

get her a copy of the clinical manual, there's extra information in there, and I feel it's best that people have something that explains what all the settings *MEAN*.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

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Re: Untreated SA may worsen . . . heart health & diabetes

Post by palerider » Sat Jun 17, 2017 10:57 am

Pugsy wrote:Centrals aren't a cause for panic...some may or may not be real so that is a factor...and even if real there are ways to deal with them if they are numerous enough to present a problem or of a duration to present a problem. Cross that bridge if or when it needs to be crossed.
I don't have more than a feeling, but I believe that obstructives are a much bigger problem than pressure induced centrals... because of the .... 'jolt' they give the body when they arouse you and you gasp for air, spiking blood pressure, increasing urine output, releasing stress hormones... vs the centrals of you just not feeling the need to breath for a bit longer than the machine likes.

I'm not saying centrals should be ignored, just that they're not as important, especially at first.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

Arlene1963
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Re: Untreated SA may worsen . . . heart health & diabetes

Post by Arlene1963 » Sat Jun 17, 2017 11:44 am

Thanks Pugsy and Palerider

Hi DH, I will start a new thread if necessary
Last edited by Arlene1963 on Thu Oct 26, 2017 4:02 am, edited 3 times in total.

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Re: Untreated SA may worsen . . . heart health & diabetes

Post by palerider » Sat Jun 17, 2017 1:57 pm

Arlene1963 wrote:Thanks Pugsy and Palerider

Hi DH, I will start a new thread if necessary ... I will be talking to her a lot over the next few weeks and will update to a new thread rather than here, so I am editing out (deleting) the additional SH chart I just posted here about an hour ago showing another day's data earlier this week. If necessary I will post it to a new thread.
please *do not shrink* the images.

when you post with imgur, select "large thumbnail" at the bottom of the box on the right, which will give you a link to a reduced image, but we can still see the full size... help in my sig, if needed.

I can't see much in that shrunk image, sorry.

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Arlene1963
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Re: Untreated SA may worsen . . . heart health & diabetes

Post by Arlene1963 » Sat Jun 17, 2017 2:18 pm

Thanks so much Palerider.

I'm giving it a whirl, don't think it is quite right yet, can't click on it, but at least it is bigger than my earlier effort!

As you can see she's been having a rough time. I really hope to be able to help her through this. And thanks to you and Pugsy for helping me help her!

Editing to make it clickable, thanks to Palerider's instructions (and patience). I actually read the instructions this time instead of winging it.


Image
Last edited by Arlene1963 on Sat Jun 17, 2017 3:21 pm, edited 2 times in total.

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Re: Untreated SA may worsen . . . heart health & diabetes

Post by palerider » Sat Jun 17, 2017 3:07 pm

Arlene1963 wrote:Thanks so much Palerider.

I'm giving it a whirl, don't think it is quite right yet, can't click on it, but at least it is bigger than my earlier effort!
here's a good step by step on how to get the image posted *just right* on imgur:

https://sleep.tnet.com/reference/tips/imgur

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

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Re: Untreated SA may worsen . . . heart health & diabetes

Post by palerider » Sat Jun 17, 2017 3:29 pm

Arlene1963 wrote:Thanks so much Palerider.
As you can see she's been having a rough time. I really hope to be able to help her through this. And thanks to you and Pugsy for helping me help her!
yes, it's obvious that she needs more pressure...

when(if) you get her to change to auto, then seeing the snore and flow limitation strips could help too.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.