At Wits End--start over with sleep study?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Jackcrosby

At Wits End--start over with sleep study?

Post by Jackcrosby » Sun Nov 29, 2015 2:16 pm

Hello all---I often read the posts here with a lot of interest. I am on other boards for various interests but none contain the giving, willingness to help as does this CPAP community. I am having a huge upswing in AHIs from my average of 12-15 per hour to a whopping 30-40 or so the past few nights.

I started CPAP therapy right at 3 years ago but still consider myself as a newbie. I see that to provide help and advice specifics are needed by the members of the board and I hope I don't over do that so here are some specifics;

Equipment, Respironics Remstar Auto A-Flex system one. (Model # DS560S)
Humidifier--On hand but not used. No problems with dry mouth.
Mask, Mirage Quattro, Large.
Software--none obtained yet.
Settings, Auto CPAP,min, C-Flex 2, Auto max, 12.5, Min, 7.

Personal, male, 6' tall, 240 pounds, BMI 29.0, 76 years old, always perfect health but diagnosed with a-fib a week ago. Dr. expects it is transitory and will be resolved with a 2 week course of meds. Causing some breathing problems but better each day. Now at 4 days of the two week course of meds. No other health issues. Still work as a business broker--maybe 25 hours a week.

Sleep study 3 years ago. Not well done. 454 minutes, total sleep time,200 minutes. Sleep latency 114.5 minutes, Stage REM latency, 256 minutes. Stage N1 sleep, 32%, Stage N2 sleep 7.8%, stahe N3 sleep 0% and Stage R sleep 10.3%. (I have no clue what these mean.)

The Report shows that the pre AHI treatment was 59.4 and after CPAP treatment the AHI was 38. During REM sleep the AHI was 11.7 / hour nd during NREM sleep the AHI was 52.8, non-supine being 44.9. The report states that "an optimal pressure setting was not found as patient was not able to achieve REM sleeptowards the end of the study. Therefore Auto-CPAP is suggested."

So----I was put on Auto-CPAP at 10-20 cm H20 pressure. This setting blew the bmask right off my face resulting in noise and lots of leaks. I told the sleep doc about this and I was "allowed' to lower the max to 18. (!) the result at 18 was the same so I eventually lowered the max pressure to 12.5---not smart I now know but the higher pressures pumps air into my stomach and gives ne sharp stomach pains. So I am in a mess right now and am reaching out for advice.

It seems that before my A-fib issue I was doing well with the 12.5 max and feeling alert throughout the day. Now with the huge AHIs, I get that same awful feeling of dozing off at my desk or watching TV that I had before starting on CPAP.
I know I need the CPAP therapy and am religious about using it.

I feel that I have my mask adjusted well with zero leaks but I do fiddle with it every night. I know my pressure is screwed up and the timing suggests the A-fib has something to do with it. Until I get the a_fib corrected my breathing will be labored sometimes and good at other times. It is improving daily.

I will be grateful if the brain trust I know we have here will point me in the right direction.

Thanks so much and happy holidays to everyone. Jack Crosby, Hot Springs, AR

yaconsult
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Re: At Wits End--start over with sleep study?

Post by yaconsult » Sun Nov 29, 2015 2:53 pm

Welcome. Please add your equipment to your profile so it gets appended to all your posts.

Start by downloading the wonderful free SleepyHead software from here: http://www.sleepfiles.com/SH2/

This will allow you to see the details of what is actually happening throughout your night.

I'm a little confused about your description of the mask being "blown off your face" at a setting of 10-20. The machine will stay at the lower pressure unless it thinks it needs to raise it to treat apneas that it detects. You may have mask fitting issues. Be sure to add your mask details when you fill out your profile so that we know what you are using. Have you tried any other masks? I have my pressure set at 13-20 and have no leak issues with the AirFit P10 nasal pillows.

Expect some advice soon from the more experienced forum members, but in the meantime, see if you can get sleepyhead installed and working and read the data from your machines memory card. At some point, people will need to see the graphs from sleepyhead.

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Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Additional Comments: January 2015 Sleep Study Results: Apnea/Hypopnea Index (AHI): 80.2, Sleepyhead

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Julie
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Re: At Wits End--start over with sleep study?

Post by Julie » Sun Nov 29, 2015 2:57 pm

I'd try a lower low setting rather than lowering the high one (as has been said), because it's the one that determines how well you're doing with the machine. You may just not need it so high, and feel free to actually raise the higher one a bit (e.g. to 15) because it shouldn't affect anything.

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Pugsy
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Re: At Wits End--start over with sleep study?

Post by Pugsy » Sun Nov 29, 2015 3:35 pm

What is that higher than you want AHI made up of?
You will need to use the software to see what the AHI is made up of...as in which category do the events fall.
AHI is made up of
ClearAirway/Central Index
Obstructive Airway Index
Hyponea Index

Before I changed anything with the pressures I would want to make sure that what I was wanting to fix with a pressure change is fixable with a pressure change.

Software..this will work well with the PR S1 560 machine. Let's see what the machine is doing before going around changing things. See this link for getting the software.
https://sleep.tnet.com/equipment
examples of what you can see can be found here viewtopic/t103468/Need-help-with-screen-shots.html

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I may have to RISE but I refuse to SHINE.

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Sleeprider
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Re: At Wits End--start over with sleep study?

Post by Sleeprider » Sun Nov 29, 2015 3:50 pm

Jack, you have experienced some health changes with the A-Fib that may make you more susceptible to central apnea and hypopnea. You might find your answer by getting a new sleep study, particularly a titration study; or you could very easily use the data you have right on the SD card on your machine and with the help of the forum, get some guidance towards a solution.

It may well be your needs have changed, and the APAP may or may not be able to address that. You need to either schedule your consultation with a sleep doc, or get a better understanding of what is happening using software.

It doesn't get any easier. Download the software here: http://www.sleepfiles.com/SH2/
Learn how to post the data to get help here using this tutorial: https://sleep.tnet.com/reference/tips/imgur

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Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
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JDS74
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Re: At Wits End--start over with sleep study?

Post by JDS74 » Mon Nov 30, 2015 6:40 pm

Jack:

To get the best help, please register for this forum. That way you will be able to post information about your equipment and have it show up in each post you make.

A pre-CPAP AHI of 59 is severe and means that even though you have felt in perfect health, the untreated apnea has given you problems. AFIB is one of the kinds of problems of untreated (or not properly treated) apnea.

The assignment of the Respironics Auto cpap (model 560) seems to have been a guess and should be followed up with an analysis of the data the machine collects. Has you doctor looked at your SD card and gotten a report?

Pending using SleepyHead to generate your own reports, you can look at the numbers on the LCD screen on the 560. It provides a 7 day and a 30 day average which might be a little helpful.

As you seem to be quoting from the sleep study report, could you go back and see what the breakdown in for the AHI numbers? It is important to know what the number of CA's (central apneas) was during the titration part of the study.

Now, after 3 years, you are tolerating the machine at night, it would seem prudent to ask your doctor to schedule another sleep study and see if the machine you have is correct for you. With a sleep latency of 114 minutes, you had difficulty getting to sleep and that made the titration study not very effective. You may need a different one from the straight auto CPAP you now have.

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Wulfman...
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Re: At Wits End--start over with sleep study?

Post by Wulfman... » Mon Nov 30, 2015 6:54 pm

If you have A-Fib, I'd suggest NOT using a range of pressures........and definitely use software like Sleepyhead to see what's going on.


Den

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(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
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