My CPAP Treatment Journey

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
WindCpap
Posts: 394
Joined: Fri Oct 09, 2015 6:57 pm

Re: My CPAP Treatment Journey

Post by WindCpap » Tue Nov 24, 2015 8:45 am

Use mask fit to blow out water. Nothing recorded.

Also, I gave up on the Mask-Off count. I always get up to pee once so I can never score greater than 99.

Sleepyhead will give you a far better view of your data than My air. I use autoramp for comfort, and to tell when I fell asleep in sleepyhead. I remove all sessions that never ramp up, and once that I know I reset to get a better view of the data.

_________________
MachineMask

Heart Jumping
Posts: 276
Joined: Wed Jul 22, 2015 3:06 pm

Re: My CPAP Treatment Journey

Post by Heart Jumping » Wed Nov 25, 2015 8:52 am

Update. I'm facing some challenges and need advice. Now that I've done this for a week I have a better feel for what's going on. I often have congestion in one nostril, often so much so that I'm mainly breathing out of one nostril. What is happening is that on nights where I don't have much congestion I am doing OK. The night before last was my best night since starting.

However last night I had congestion where one nostril was pretty congested and that's when I am having a very difficult time, I feel as though I'm struggling to get enough oxygen and even feel like I'm suffocating at times. After about 4 hours I couldn't stand it any more and took it off. I've tried Flonase nasal spray in the past with little to no reduction in congestion. I don't think a full face mask would help because I'm not a mouth breather?

I'd also like to know if there is anything I can do to reduce my AHI's? I'm not as obsessed as some here with having them at some ultra low number, but right now they are averaging 8 - 9 and that seems too high. Although that's not my top priority, maybe once I can sleep with some consistent comfort and/or improve this challenge with using CPAP when congested those numbers will improve.

I'm going to also start a dedicated thread on the congestion issue to hopefully catch the attention of people who've faced this issue.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: DreamWear Nasal CPAP Mask with Headgear - Fit Pack (All Cushions Included with Medium Frame)
Additional Comments: AirFit F10 Full Face Mask is my backup mask for when congested.

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: My CPAP Treatment Journey

Post by Pugsy » Wed Nov 25, 2015 8:57 am

Heart Jumping wrote:I'd also like to know if there is anything I can do to reduce my AHI's? I'm not as obsessed as some here with having them at some ultra low number, but right now they are averaging 8 - 9 and that seems too high.
Depends on what they are and what's causing them.
More information is needed to have any idea what you could or should do...like the AHI breakdown into each category...and when are these events happening ....and what pressures are being used.
In other words it would help a lot if we see what you are seeing on the software detailed reports.

In case you haven't mastered posting images of your reports...explained below
Screen shot thread that is better with examples viewtopic/t103468/Need-help-with-screen-shots.html
and general how to post images
https://sleep.tnet.com/reference/tips/imgur

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

Heart Jumping
Posts: 276
Joined: Wed Jul 22, 2015 3:06 pm

Re: My CPAP Treatment Journey

Post by Heart Jumping » Wed Nov 25, 2015 9:06 am

Does this give you what you need?

Image

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: DreamWear Nasal CPAP Mask with Headgear - Fit Pack (All Cushions Included with Medium Frame)
Additional Comments: AirFit F10 Full Face Mask is my backup mask for when congested.

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: My CPAP Treatment Journey

Post by Pugsy » Wed Nov 25, 2015 9:21 am

Can you turn off the mask pressure graph and instead include the Flow Limitation graph (don't need the snore graph either)?

Is it possible that you were awake during the clusters of CAs?
Like the 8:30 grouping....where the pressure spikes also?
Is it possible you were awake with the congestion during that time frame?

The CAs we can't do anything about with this machine and they may not need anything done about them anyway.
Your AHI is primarily CAs (Centrals) which could be awake/semi awake centrals and if they are we ignore them.
Your OAs are technically under 5 so not urgent that they be reduced but if you want to try to reduce them then most likely a little more minimum pressure is the key...not maximum.
These machines work best at preventing the airway from collapsing and that involves using a little more minimum or baseline pressure.
If the CAs happen to be post arousal from the OA happening then maybe they will reduce if the OAs are reduced.

What humidity setting are you using? Have you played with the humidity setting to see if one way or the other (more or less) seems to help or hurt the nasal congestion?
Using a little higher minimum might also help you get past the feeling of not enough air movement during the times when one nostril is congested.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

WindCpap
Posts: 394
Joined: Fri Oct 09, 2015 6:57 pm

Re: My CPAP Treatment Journey

Post by WindCpap » Wed Nov 25, 2015 11:25 am

I am in agreement with Pugsy about the minimum pressure. Your median pressure was 9, and more than likely, it is a good starting pressure. Remember, that you can use auto-ramp for comfort while you are awake, and then have the machine ramp up a couple of minutes before you actually fall asleep. I know there is a lot of push-back from the group about ramp and auto-ramp but very few people actually use it, and, as an auto-ramp user, I can tell you that it works extremely well. Also, it will not go back into ramp mode until you reset it, so you don't have to worry about it interpreting when you wake up incorrectly. Your machine will not record events in ramp mode, so this eliminates some (but not all) of the guess work of figuring out whether or not an event happened when you were awake. It also prevents the machine from responding to things that are happening while you are still awake. This may help you to fall asleep easier.

As for the central apneas, the detection works properly most of the time, but not all of the time, and does a very poor job of detection mixed apnea. These start as a central apnea, and turn into an obstructive apnea. I had one that woke me up gasping for breath, and the machine recorded it as a central. I could see from the close up of the flow waveform that it was one of my typical 10-11 second centrals during REM sleep that extended to 17 seconds. Incidentally, I never experienced on OSA consciously like that before, and it scares the crap out of me that this was happening 37 times per hour prior to getting my CPAP. The way to see if a central was recorded properly is to look at your breathing pattern immediately after. If the waveform gets substantially bigger or more eratic , it was an OSA. If it stays about the same as the rest of your sleeping pattern, it is a central.

Finally, I know there is disagreement about the effect of EPR on OSAs. If you use auto-ramp, you can use ramp only EPR, and have it turn off when you are asleep. I don't notice that the EPR is not there when I wake up, and have 9 cmH20 constant pressure. Getting rid of the extra flow induced by the EPR may help to reduce your nasal congestion. I actually avoid resetting the ramp because the constant pressure does help keep my nasal passages open. I am considering phasing EPR out altogether, and phasing out most of the ramp, in the end keeping it at 8.8 cmH20 just so that I know when I fall asleep in my data.

_________________
MachineMask

User avatar
ChicagoGranny
Posts: 14409
Joined: Sun Jan 29, 2012 1:43 pm
Location: USA

Re: My CPAP Treatment Journey

Post by ChicagoGranny » Wed Nov 25, 2015 12:05 pm

Heart Jumping wrote:... in the morning I always have nasal congestion. For as many years as I can remember. ... on nights where I don't have much congestion ...
CPAP doesn't solve all problems.

Have you recently had a consultation with an ENT/Allergist? He should perform an In-Office Nasal Endoscopy & Laryngoscopy (http://www.tampaent.com/treatments-nasa ... el-fl.html) on your first visit. It only take a few minutes. He may also want to do some allergy testing afterwards.

Gramps had problems with CPAP when he started out. Relief did not come until he got help from an ENT.

No use suffering. The first visit is usually just a $50 copay.

Heart Jumping
Posts: 276
Joined: Wed Jul 22, 2015 3:06 pm

Re: My CPAP Treatment Journey

Post by Heart Jumping » Thu Nov 26, 2015 12:21 pm

Pugsy,

Not at home over the holiday so can't answer your questions yet, as I don't have the machine I use with sleepyhead with me. However last night was my best sleeping night yet and suddenly my events plummeted. Slept 6 hours straight with only 3.6 events per hour as reported by the S10. So that might mean my obstructive events were less than 1.

Still not waking up feeling much different than before CPAP, I just keep telling myself to be patient on that front. But excited that I had a decent nights sleep and at least didn't wake up exhausted, even if not with energy.

WindCPAP,

Thanks for advice. I may experiment with some of the settings you suggest, as I've been starting out I've been trying not to change too many things at one time, so that if a variable makes a change, I'll have a better chance of knowing which change might have effected it. First I turned off ramp. Then adjusted max pressure. Next I might shoot up minimum pressure a bit and use ramp again if I do. Though based on last nights excellent results part of this may just be continuing to adapt to sleeping with CPAP.

Granny,

Many thanks, that advice prompts me to do just that, I'm going to schedule an appointment next week. It's one of those things that because it's had minimal impact on my life I've just accepted, but as you point out there's no reason to do that when it may be something that can be improved.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: DreamWear Nasal CPAP Mask with Headgear - Fit Pack (All Cushions Included with Medium Frame)
Additional Comments: AirFit F10 Full Face Mask is my backup mask for when congested.
Last edited by Heart Jumping on Thu Nov 26, 2015 8:18 pm, edited 3 times in total.

User avatar
LSAT
Posts: 13229
Joined: Sun Nov 16, 2008 10:11 am
Location: SE Wisconsin

Re: My CPAP Treatment Journey

Post by LSAT » Thu Nov 26, 2015 2:17 pm

Heart Jumping wrote:Pugsy,

Not at home over the holiday so can't answer your questions yet, as I don't have the machine I use with sleepyhead with me. However last night was my best sleeping night yet and suddenly my events plummeted. Slept 6 hours straight with only 3.6 events per hour as reported by the S10. So that might mean my AHI's were less than 1.

Still not waking up feeling much different than before CPAP, I just keep telling myself to be patient on that front. But excited that I had a decent nights sleep and at least didn't wake up exhausted, even if not with energy. First I turned off ramp. Then adjusted max pressure. Next I might shoot up minimum pressure a bit and use ramp again if I do. Though based on last nights excellent results part of this may just be continuing to adapt to sleeping with CPAP.

WindCPAP,

Thanks for advice. I may experiment with some of the settings you suggest, as I've been starting out I've been trying not to change too many things at one time, so that if a variable makes a change, I'll have a better chance of knowing which change might have effected it.

Granny,

Many thanks, that advice prompts me to do just that, I'm going to schedule an appointment next week. It's one of those things that because it's had minimal impact on my life I've just accepted, but as you point out there's no reason to do that when it may be something that can be improved.
If your machine reported 3.6 events per hour...your AHI was 3.6...not <1.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: Fisher & Paykel Vitera Full Face Mask with Headgear (S, M, or L Cushion)
Additional Comments: Back up is S9 Autoset...... Buckwheat hull pillow

Heart Jumping
Posts: 276
Joined: Wed Jul 22, 2015 3:06 pm

Re: My CPAP Treatment Journey

Post by Heart Jumping » Thu Nov 26, 2015 3:01 pm

LSAT wrote:If your machine reported 3.6 events per hour...your AHI was 3.6...not <1.
Thanks for the correction so I get in the habit of using correct terminology, I meant that my obstructive events might be less than 1. I'm under the impression that the Resmed events number is the combination of obstruction and central events, correct me if I'm wrong. So I'll need to look in Sleepyhead to see how much of the 3.6 was obstruction. And if it follows the other nights I've looked at and centrals represent the majority, than that means the obstructive events could be less than 1.

So then I need to learn to analyze the central events to figure out if they really are central events.

For people diagnosed with obstructive sleep apnea, once they are on cpap, is it normal for there to be more centrals or more obstructive events?

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: DreamWear Nasal CPAP Mask with Headgear - Fit Pack (All Cushions Included with Medium Frame)
Additional Comments: AirFit F10 Full Face Mask is my backup mask for when congested.

Heart Jumping
Posts: 276
Joined: Wed Jul 22, 2015 3:06 pm

Re: My CPAP Treatment Journey

Post by Heart Jumping » Thu Nov 26, 2015 3:13 pm

I probably should have posted my sleep study results at the beginning in case that helps, instead of just saying "37 AHI". Here were the results (over a period of a few hours):
- 0 obstructive apneas
- 74 hypopneas (72 were associated with a 3% oxygen desaturation),
- 2 mixed apneas
- 10 central apneas
- 1 respiratory effort related arousals
- Lowest oxygen 86%

Which averaged out to an apnea/hypopnea index of 37. Diagnosis: severe obstructive sleep apnea

Can report other stats upon request.

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: DreamWear Nasal CPAP Mask with Headgear - Fit Pack (All Cushions Included with Medium Frame)
Additional Comments: AirFit F10 Full Face Mask is my backup mask for when congested.

User avatar
ChicagoGranny
Posts: 14409
Joined: Sun Jan 29, 2012 1:43 pm
Location: USA

Re: My CPAP Treatment Journey

Post by ChicagoGranny » Fri Nov 27, 2015 7:29 am

Heart Jumping wrote:I'll need to look in Sleepyhead to see how much of the 3.6 was obstruction.
On the previous model of your machine, you can get into a second report on the display and see there the breakdown between obstructive and central apneas. It takes a second to get into the report, and I like to do it when I get up each morning.

Maybe someone with your model machine will post how to get that report on the display.

WindCpap
Posts: 394
Joined: Fri Oct 09, 2015 6:57 pm

Re: My CPAP Treatment Journey

Post by WindCpap » Fri Nov 27, 2015 10:43 am

ChicagoGranny wrote:
Heart Jumping wrote:I'll need to look in Sleepyhead to see how much of the 3.6 was obstruction.
On the previous model of your machine, you can get into a second report on the display and see there the breakdown between obstructive and central apneas. It takes a second to get into the report, and I like to do it when I get up each morning.

Maybe someone with your model machine will post how to get that report on the display.
in the clinical menu you change essentials from "on" to "plus". More info shows up in the lcd report. if you want last night's info, you need to switch the report from 30 days to 1 day.

_________________
MachineMask

Heart Jumping
Posts: 276
Joined: Wed Jul 22, 2015 3:06 pm

Re: My CPAP Treatment Journey

Post by Heart Jumping » Sun Nov 29, 2015 12:37 pm

A couple of observations/questions.

1. Lately I've been getting up at least once during the night, often after 4 - 6 hours of sleep. If I look at the Resmed display at that time, total events will typically be around 3. Then I'll go back to sleep and when I get up events are much higher, between 7-10. I assume the Resmed combines the events from the two sleep events into one, if so that means the number of events in the second sleep event are even much higher, enough so that its increasing the average for the entire sleep cycle. Either way events are still higher in the second sleep cycle.

Is this common? Any theories for why? I can post SH results of a day in question if that's needed.

2. As I'm laying awake as I'm trying to fall asleep at times I'll suddenly feel big increases in pressure, sometimes slightly uncomfortable as if they are really forcing my lungs full. I'll reach over and look at the display and see my pressure is on the top half of my range.
a. Does this mean the machine detected an event and increased pressure? Is that what I'm experiencing or is this just me picking up on changing pressure levels as I fall asleep?
b. How quickly can the machine ramp and is their a limit to how extreme it ramps within a given minute? Is there a spec on that? For instance, if my range is 8 - 15, could it ramp from 8 - 15 in 30 seconds? 3 minutes? Not talking about autoramp which I do have engaged, I'm talking about once it's no longer engaged and I'm within my specified range.

Thanks

_________________
Machine: ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier
Mask: DreamWear Nasal CPAP Mask with Headgear - Fit Pack (All Cushions Included with Medium Frame)
Additional Comments: AirFit F10 Full Face Mask is my backup mask for when congested.
Last edited by Heart Jumping on Sun Nov 29, 2015 2:18 pm, edited 1 time in total.

HoseCrusher
Posts: 2744
Joined: Tue Oct 12, 2010 6:42 pm

Re: My CPAP Treatment Journey

Post by HoseCrusher » Sun Nov 29, 2015 1:50 pm

A couple of thoughts...

Sleep breathing is different than breathing while awake. Often the transition from wake to sleep is "eventful." Since the machine doesn't know if you are sleeping or awake, it just scores the events.

I use ramp to eliminate the sudden rush of air you are experiencing. I have a ramp of 10 minutes and the initial pressure is just a little below my normal pressure. I usually fall back to sleep before the ramp has finished and the initial pressure is high enough that I don't feel "starved for air."

Each machine is different. You would have to look at the details for your machine to see how quickly it responds.

_________________
Mask: Brevida™ Nasal Pillow CPAP Mask with Headgear
Additional Comments: Machine is an AirSense 10 AutoSet For Her with Heated Humidifier.
SpO2 96+% and holding...