Build Home Sleep Lab < $1000

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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avi123
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Re: Home Sleep Lab < $1000

Post by avi123 » Thu Oct 20, 2011 6:44 pm

Jay Aitchsee wrote:
avi123 wrote:.... Also, if I could avoid doing PSG, often, why not find a In Home system which would indicate vital signs of wrong treatment and cost a lot cheaper?....

p.s. Jay, looking at your graphs I don't see anything wrong and your events are miniscule. IMO, your sleep fragmentation comes from some underying medical conditions which are not related to respiration or sleep architecture. How about Diabetes, Depression, hi Epworth sleepiness score, alcohol, smoking, •Neurologic syndromes, etc.?....
Right on both counts! Ergo my home system and my ealier comments about having more the one problem. I feel I have the respiratory portion under control, althought it took me a number of years to do it. And I think you hit the nail on the head about not trusting the techs. It's not that they're incompetent. I think it's because they're working with only one data set. A person goes to the lab, gets titrated (which may be right for that night under those conditions) and is sent home with a CPAP and a pressure setting. I think a person is extremely lucky if that works for them. For me it didn't work, I didn't feel better, so I wasn't compliant. It took a couple years for me to learn I could get data from my CPAP. Once I did, I started self titrating and got my AHI down to around 6 or so. I found the software, bought an autoset out of pocket, became compliant and got my AHI down to around 3. I have learned an APAP works better for me, that my ideal pressures changes with time, and that even though I have the respiratory portion under control I still don't get restorative sleep. Now, I was diagnosed with moderate to severe apnea and severe PLMD so I knew I had more than one problem, but I feel earlier attempts to treat the PLMD failed because I was not compliant and the only measure of success was whether or not I felt better. Well, of course I didn't feel better, I wasn't compliant so the PLMD meds might have worked but my sleep was fragmented by the apnea so there was no way to know. Now my Dr and I are trying the meds again and just last week we ordered full blood work to help rule out the things you mentioned. This included a metabolic panel, kidney function, Vitamins D, B's, iron, thyroid, etc., I am waiting the results now. I am hopeful that I will eventually find the root cause of my non-restorative sleep (I didn't see statins in your list) or at least a med that will treat it, but I don't expect it to be easy.
So, back to you, I'm not sure I understand your data, but it looks like your best pressure is around 7? Don't you have an autoset now? When I was doing my titration with a CPAP, the best advice I got from a sleep Dr was to start low. My prescibed pressure was 10 and I was working around that but not getting anywhere. One problem was leaks. I couldn't get them under control. So I went to 7 and stayed there untill I got the leaks under control. Then I increased my pressure by .5 and stayed there until I got my leaks under control or at least a week. I found it took some time for my AHI to stabilize after a change in pressure. I kept this up until I reached about 9.5, my AHI had dipped and I started back down. Anyway, I ended up about 8.5. When I got my autoset, I set it for 7-12 and its median pressure came back at about the same around 8.4, but because it could control some of the apneas that needed a higher pressure, my AHI dropped. So, my point is I think self titration is possible, but it's a slow process even with an APAP. It appears to me the body must be given time to adjust after each change and leaks must be controlled or titration won't be successful.
Avi, this is a long rambling post the point of which I'm not sure, but I think we agree about treatment; some type of self monitoring is probably necessary for success, sleep disturbances aren't necessarily limited to respiratory factors, and those that expect to feel better just because they get a cpap are likely to be dissapointed - it takes work.

(I didn't see statins in your list) or at least a med that will treat it

Reply: the list does not refer to my daily Rx.

I take statin daily:

Simvastatin 20 mg (generic Zocor) tab, anti Cholesterol
Meloxicam 7.5 mg (Mobicox) tab, NSAID for artrithis
Avalide 150/12.5 mg, anti hi blood pressure (stopped taking)
Amlopidine Besylate (Norvasc) 5 mg, anti hi blood pressure
Actos 30 mg tab, anti Diabetes
Xanax 0.5 mg, twice daily for antidepression and sleep
Flomax 0.4 mg, for reducing sleep frequent urination

Vitamins & other:

Prilosec, two tablets daily
Centrum A to Z
Vitamin B12- 1 mg
Vitamin D (50000) weekly
I-Caps
Aspirin 81 mg (every other day)
DSS 50 mg stool softener (two)
Acidophilus capsule- one, to counter the Dicloxacillin
Biotene mouthwash-for dry mouth

XXXXXXXXXXXXXXXXXXXXXX

As to my AHIs, firstly, I don't believe in them as the report in my signaure line attests. Secondly, I could not find a correlation (or a Trend) between the AHIs and the pressure that I been getting from my S9 Autoset data for the last six months. This also baffles my sleep MD and a reason to adding more At-Home Sleep Clinic's equipment for verifications. See here a sample of the randomness of pressure vs AHI in my ResScan summary graphs:



Image

Image

Image

Jay, do you see a TREND in my data?

_________________
Mask: Mirage™ SoftGel Nasal CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments:  S9 Autoset machine; Ruby chinstrap under the mask straps; ResScan 5.6
Last edited by avi123 on Sat Oct 22, 2011 8:08 am, edited 1 time in total.
see my recent set-up and Statistics:
http://i.imgur.com/TewT8G9.png
see my recent ResScan treatment results:
http://i.imgur.com/3oia0EY.png
http://i.imgur.com/QEjvlVY.png

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Jay Aitchsee
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Re: Home Sleep Lab < $1000

Post by Jay Aitchsee » Fri Oct 21, 2011 9:03 am

Good Morning,
First, sorry about the misunderstanding about the list. What I meant was I didn't see statins on your list of things that could cause disturbed sleep in general (all of which I agree with, BTW) not your personal list. I threw statins in there because there was a study done in 2007 (http://www.medpagetoday.com/MeetingCoverage/AHA/7301) that links fat soluble statins like zocor to disturbed sleep. I have long thought statins have disturbed my sleep and I even quit taking them (zocor) for a while but it didn't help, again in my non-compliant days. Next month, when I visit my GP, I am going to have my prescription changed to pravastatin (water soluble) and see if it helps.
On the subject of meds, I've done a couple earlier posts, citing that many, even those prescribed for sleep, inhibit deep sleep or REM even though they may be sedating in nature. I am careful to review all the drugs I take for possible sleep disruption.
I understand your opinion of AHI and I tend to agree, but we have to start somewhere. I largely ignore my AHI, putting more weight on AI alone.
Now to trends. I see your difficulty in detecting a trend, but I think there are a couple things that may be worthy of note. First I think there is a pretty clear correlation between your leaks and AI, especially in the April - June Run. See how the tops of the leak bars and AHI bars form curves that are similar? A little more difficult to see, but still there in the June - August grouping. So, keeping your leaks under control is crucial while doing titration.
Avi, I think you might have missed your optimum pressure. See back in April, those few times your leaks were good and your pressures were less than 10, you had some pretty low AI's. but then you moved on, increasing the pressure until into June-August, your leaks improved but your pressures were up to 10-15. I don't know about the S9, but I know the S8 response to apneas with pressures above 10 is limited. It's the CA thing. Another thing, IMO, is that you moved too fast in the early days of your titration (April). You went from 7 to 14 or so in less than 30 days.
So, here's what I would recommend. Start over with your titration. Start low, around 7, keep your leaks under control and don't increase the pressure until AI appears to have stabilized. When it does, increase the pressure slightly, maybe .5, let it stabilize and continue the process until you pass through a dip in AHI, then start back down watching for the dip. When you think you have the dip, set the APAP maybe 2 above and 2 below it and see where it wants to take you. If the APAP starts hitting either the low or high consistently, I'd change that one incrementally and the other too if possible, to maintain the 4 spread, again allowing for stabilization. The overall goal here is to reduce the apneas the greatest amount with the least pressure. The greater the pressure, the harder it is for your body to adjust, more CA, more leaks, etc. The other thing I must emphazise is patience, IMO it takes at least a week for your body to stabilize after a change in pressure so we're talking about weeks if not months to find an optimum pressure.
What do you think?
Jay

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Auto, P10 mask, P=7.0, EPR3, ResScan 5.3, SleepyHead V1.B2, Windows 10, ZEO, CMS50F, Infrared Video
Last edited by Jay Aitchsee on Sat Oct 22, 2011 6:56 am, edited 1 time in total.

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avi123
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Re: Home Sleep Lab < $1000

Post by avi123 » Fri Oct 21, 2011 6:40 pm

Thanks Jay. You do make sense. I am preparing more of my graphs to post. In the mean time I am looking into Watch-Pat from Itamar Medical, if it could also be a prospective device to monitor my data in addition to the APAP. You can see data about it here:



http://www.centerforsoundsleep.com/blog ... onitoring/


The Watch PAT you do at home and then send the results to their centers for diagnosis, similar to IDS, SleepScout with SD memory card, etc.

_________________
Mask: Mirage™ SoftGel Nasal CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments:  S9 Autoset machine; Ruby chinstrap under the mask straps; ResScan 5.6
see my recent set-up and Statistics:
http://i.imgur.com/TewT8G9.png
see my recent ResScan treatment results:
http://i.imgur.com/3oia0EY.png
http://i.imgur.com/QEjvlVY.png

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Jay Aitchsee
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Location: Southwest Florida

Re: Home Sleep Lab < $1000

Post by Jay Aitchsee » Sat Oct 22, 2011 6:46 am

Hmmm, the Watch Pat is interesting. Looks likes they combine serveral sensors neatly. What do they charge for a reading?

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Auto, P10 mask, P=7.0, EPR3, ResScan 5.3, SleepyHead V1.B2, Windows 10, ZEO, CMS50F, Infrared Video

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Jay Aitchsee
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Re: Home Sleep Lab < $1000

Post by Jay Aitchsee » Sat Oct 22, 2011 8:14 am

Hello Avi,
I just saw your post in another thread where you stated your recommended pressure following your PSG was rather low, around 6 I think. That seems to fit with what I saw looking at your graphs.
Why not, as an experiment, try setting your APAP to 6-10 and letting it run for a week or so? That might provide some insight as to what your optimum pressure might be and it might also provide some insight as to the influence of other factors such as leaks. If you do the experiment, I recommend leaving EPR off. EPR seems to have a negative impact on effectiveness. Also, if you choose to do the experiment, it is important not to change the pressures so that your body has time to adjust and meaningful data is produced.
What do you think? Want to try it?
Jay

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Auto, P10 mask, P=7.0, EPR3, ResScan 5.3, SleepyHead V1.B2, Windows 10, ZEO, CMS50F, Infrared Video

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avi123
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Re: Home Sleep Lab < $1000

Post by avi123 » Sat Oct 22, 2011 9:26 am

Jay Aitchsee wrote:Hmmm, the Watch Pat is interesting. Looks likes they combine serveral sensors neatly. What do they charge for a reading?

Yes, I agree that the Watch PAT 200 is nice and could be valuable to me in addition to my S9 Autoset. My sleep MD and myself don't agree that our home XPAPS are suitable to provide reliable diagnostic data besides machine's time and probably of mask leak.

The following Watch PAT 200 reports were taken from this blog by Dr Lawler:

http://www.centerforsoundsleep.com/blog ... onitoring/

Image

Contrast the healthy sleeping pattern shown in the above report with this one of a patient with severe sleep apnea.

Image


Image

more to come, I have problems posting today.

As to price, according to this source, it should be similar to IDS Diagnostics (with the Resmad ApneaLink Plus) of less than $300 per one time arrangement including their reports. See it here:


viewtopic.php?f=1&t=64816&p=613391&hili ... ms#p613391

So if Medicare and other insurers would pay for it then we could do it annually and skip repeatable PSG Clinics tests.

I plan to email the Itamar Medical headoffice overseas and ask if I could rent their WatchPAT 200 for once or twice a year at low price.

BTW, the poster janknitz had it done in her home instead of at a clinic by using a WatchPAT and on this basis she was diagnosed for having OSA by Kaiser Permanente, in Calif. See her post here next to your post:

viewtopic.php?f=1&t=64807&p=605226&hili ... sg#p605226

_________________
Mask: Mirage™ SoftGel Nasal CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments:  S9 Autoset machine; Ruby chinstrap under the mask straps; ResScan 5.6
Last edited by avi123 on Thu Nov 03, 2011 2:37 pm, edited 1 time in total.
see my recent set-up and Statistics:
http://i.imgur.com/TewT8G9.png
see my recent ResScan treatment results:
http://i.imgur.com/3oia0EY.png
http://i.imgur.com/QEjvlVY.png

davelikesbeer
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Re: Home Sleep Lab < $1000

Post by davelikesbeer » Tue Nov 01, 2011 11:48 am

Jay Aitchsee wrote:Dave, I'm going to leave the code writing to you younger guys. The last code I wrote was FourTran IV or maybe some early BASIC
I use a laptop now to run my webcam for the video and I could do the oximeter with usb at the same time, I just haven't spent the time to get it working. It's another wire and since desats haven't been a problem, I just haven't been motivated.
I'm waiting for you guys to build a little box to sync everything, should be easy enough, just a little beyond my current capabilities. In the meantime, my system is a little crude but it works for me. Especially since the Zeo's first line graphic is to the nearest 5 minutes. (to the nearest 30 sec is available and tallied in reports)
Let me know when you've got the box
jay
Hahaha...I doubt I will ever have a box working. It's just a fantasy. I really don't have enough time to get all the stuff I want to, done.

I did think of another webcam option. I have a Logitech Revue which runs Google TV. Purchased for $99. I've been reading online that they are planning on pushing Honeycomb (Android OS Version) which would basically give it the capabilities of a tablet. Once this happens, one could probably connect the web cam to the Revue and write an app that does time lapsed videos with embedded time stamps.

Dave.

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Mask: Swift™ LT Nasal Pillow CPAP Mask with Headgear
Additional Comments: SleepyHead User. Tried liked Swift FX. Tried and didn't like Mirage SoftGel Nasal Mask. Previously used PSR1 Auto
CPAP for the rest of your life.

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Jay Aitchsee
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Re: Home Sleep Lab < $1000

Post by Jay Aitchsee » Thu Nov 03, 2011 9:34 am

Thought you might find this interesting too. Below is a graph of my "ZQ" and deep sleep as recorded by my Zeo. At the red arrow is where I discontinued a PLMD medication and began Vitamin D3 and Vitamin B12 supplements. Really too soon to tell anything, but interesting.
Jay

Image

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Auto, P10 mask, P=7.0, EPR3, ResScan 5.3, SleepyHead V1.B2, Windows 10, ZEO, CMS50F, Infrared Video

davelikesbeer
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Re: Home Sleep Lab < $1000

Post by davelikesbeer » Thu Nov 03, 2011 11:04 am

Jay Aitchsee wrote:Thought you might find this interesting too. Below is a graph of my "ZQ" and deep sleep as recorded by my Zeo. At the red arrow is where I discontinued a PLMD medication and began Vitamin D3 and Vitamin B12 supplements. Really too soon to tell anything, but interesting.
Jay

... image removed...
Hi Jay,

What is the left axis label?

Also, how well did you sleep on the day you didn't use Zeo? The exponential decay of deep sleep looks as though you skipped a night of sleeping all together.

I can't wait to get my Zeo mobile next week. I really want to see what is going on with my sleep.

Dave.

_________________
Mask: Swift™ LT Nasal Pillow CPAP Mask with Headgear
Additional Comments: SleepyHead User. Tried liked Swift FX. Tried and didn't like Mirage SoftGel Nasal Mask. Previously used PSR1 Auto
CPAP for the rest of your life.

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Jay Aitchsee
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Re: Home Sleep Lab < $1000

Post by Jay Aitchsee » Thu Nov 03, 2011 3:57 pm

Dave,
The left axis is minutes and Zeo Quotient (ZQ). ZQ is a quality score of sleep, plus for number of hours slept, number of minutes in REM, number of minutes in deep, and minus for disruptions and time awake. Above 60 is pretty good for me. I would like to see it above 70. Younger people might expect to see scores above 80.
The night before the red arrow (10/26) I didn't wear the Zeo so there is a gap in the data. What was really surprising was the dramatic increase in deep sleep, coincident with stopping the meds and starting the supplements. Unfortunately, since I did both at the same time, I don't know which was the causative factor. Probably some of both. The exponential decline is interesting and it seems at this point to be leveling off at a somewhat higher level than before (a good thing), but, as I said, too early to tell.
So, you decided on the mobile? That's cool, be waiting for your report.

Jay

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Auto, P10 mask, P=7.0, EPR3, ResScan 5.3, SleepyHead V1.B2, Windows 10, ZEO, CMS50F, Infrared Video

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avi123
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Re: Home Sleep Lab < $1000

Post by avi123 » Thu Nov 03, 2011 6:09 pm

del

_________________
Mask: Mirage™ SoftGel Nasal CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments:  S9 Autoset machine; Ruby chinstrap under the mask straps; ResScan 5.6
Last edited by avi123 on Sun Nov 13, 2011 3:22 pm, edited 1 time in total.
see my recent set-up and Statistics:
http://i.imgur.com/TewT8G9.png
see my recent ResScan treatment results:
http://i.imgur.com/3oia0EY.png
http://i.imgur.com/QEjvlVY.png

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avi123
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Re: Home Sleep Lab < $1000

Post by avi123 » Fri Nov 04, 2011 8:16 pm

This is a good place to store my new idea


Itamar Medical: Please lower the prices of the WatchPATs!

The WatchPAT which relies on a completely diff physiological method (that most of us don't understand yet ) to detect OSA is more correlated to Clinical PSG results then most of the other "At Home Testing Devices" on the market. Isn't it impressive?

Check this:


ORIGINAL RESEARCH—SLEEP MEDICINE

A comparison of polysomnography and
the WatchPAT in the diagnosis of
obstructive sleep apnea (2007)

Link:

http://www.cardiocrusaders.com/assets/f ... tchPAT.pdf


I just wished that I could buy a WatchPAT 200 for less than $350. I could then, by wearing the device, at least one night a week, varify the data that I get from my Resmed's S9 Autoset APAP. This small device would also show me my sleep architecture, which no other device or an XPAP on the market could do without a costly EEG machine attached.

Jay, how much would you pay for a WatchPAT 200 which sells for about $4,000?

Those morons at Itamar Medical could make a fortune if they lowered the prices to let us buy those devices. Instead, they have rental "DMEs" who charge for At Home Testing (one time) and don't succeed in making money!:

"If you were to pay for this out-of-pocket, a fee of $195 would be incurred for the screening (yielding a result of negative or positive). If the screening were returned as negative, your responsibility would remain at $195. If the screening proves to be positive and the physician would like further detail on your condition, that would incur an additional $90 fee for the interpretation of the positive result."

_________________
Mask: Mirage™ SoftGel Nasal CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments:  S9 Autoset machine; Ruby chinstrap under the mask straps; ResScan 5.6
see my recent set-up and Statistics:
http://i.imgur.com/TewT8G9.png
see my recent ResScan treatment results:
http://i.imgur.com/3oia0EY.png
http://i.imgur.com/QEjvlVY.png

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Lizistired
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Re: Home Sleep Lab < $1000

Post by Lizistired » Fri Nov 04, 2011 9:33 pm

Hi Jay,
I geared up last night so I thought I would post my results.
I had crazy leaks last night. I ordered new pillows today and boiled my old ones. . AHI was 1.7 compared to 0.0 and 0.1 the 2 days prior. But I slept through the leaks until 9am. That's unheard of. I'm starting to get blocks of REM lasting close to an hour and I think better blocks of deep sleep. The other thing that looks good is that even with all the apneas, which I think were arousals, they aren't happening during REM, which they did during my initial study.
I am also starting to notice the difference between waking up from REM versus waking up from light sleep. Big difference.
The sensors still misread when I first put it on. Probably from moving around and getting settled. The rest of the night is consistant though.
Image

_________________
Mask: Swift™ LT Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Swift FX sometimes, CMS-50F, Cervical collar sometimes, White noise, Zeo... I'm not well, but I'm better.

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Jay Aitchsee
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Re: Home Sleep Lab < $1000

Post by Jay Aitchsee » Sat Nov 05, 2011 7:17 am

Yes Liz, I think that looks pretty good. Big question is, how do you feel? It does look like the apneas are occuring between sleep stages, deep to light and in light. Much better than in REM. Maybe they were arousals as you said with position changes or leaks. Too bad the leak line wasn't a little flatter. I don't see the Zeo scored any awakenings, looks like close to 2hrs REM and an hour deep. your ZQ must have been 80+ (mine was 43 last night). What is you experience waking from REM vs Light?
So, how do you feel?
jay

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: S9 Auto, P10 mask, P=7.0, EPR3, ResScan 5.3, SleepyHead V1.B2, Windows 10, ZEO, CMS50F, Infrared Video

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Lizistired
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Re: Home Sleep Lab < $1000

Post by Lizistired » Sat Nov 05, 2011 10:26 am

Jay Aitchsee wrote:Yes Liz, I think that looks pretty good. Big question is, how do you feel? It does look like the apneas are occuring between sleep stages, deep to light and in light. Much better than in REM. Maybe they were arousals as you said with position changes or leaks. Too bad the leak line wasn't a little flatter. I don't see the Zeo scored any awakenings, looks like close to 2hrs REM and an hour deep. your ZQ must have been 80+ (mine was 43 last night). What is you experience waking from REM vs Light?
So, how do you feel?
jay
I was fighting the leaks all night. It was much better last night after I boiled the pillows. I also had the ZEO under my LT and didn't really readjust the mask straps. The ZEO gave me a 94. I have had one 96. I remembered looking at the clock once or twice but I guess it doesn't take 30 seconds to do that since it never registers. Or maybe not awake enough, just like it doesn't register when I remember waking to turn over.
Waking up from light sleep is a pleasant clear headed feeling and waking up from REM is staggered with thoughts that don't make sense and anxiety. The wierd thoughts were the reason I had my sleep study. I guess that was happening all night before xpap.
I stayed up late last night practicing bad sleep hygiene. The sun woke me up so I didn't get much sleep but my AHI was 0.0 again.
Liz

_________________
Mask: Swift™ LT Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: Swift FX sometimes, CMS-50F, Cervical collar sometimes, White noise, Zeo... I'm not well, but I'm better.