One of my worst nights yet

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
RestlessinWoolley
Posts: 158
Joined: Sat Feb 11, 2017 2:03 am
Location: Sedro Woolley, Washington USA

One of my worst nights yet

Post by RestlessinWoolley » Sun Feb 26, 2017 7:23 pm

Last night was terrible, i feel like my head was hit by a jackhammer. (VS2 has been disabled as there was 370 events making it impossible to read.) I remember dreaming a ton last night as well as waking up a ton. been resting all afternoon a well, as I have one heck of a headache. I cannot wait to have the new test now as its obvious this isn't working, and raising my pressure seem to further aggravate events, since for some reason, my centrals are not being flagged. I woke up about 430am and tested my Sp02 and it was 86%. March 22nd get here fast please..

Image

_________________
MachineMask
Additional Comments: Resmed AirCurve 10 ASV
EPAP Min 6, Max 15, PS Min 6, Max 21, BURR 10, Press Max 25, BPM 11, Ti 1.2

"I hate the word 'Handicapped' and 'Disabled'. They imply that you are less than whole don't see myself that way at all". ~Aimee Mullins

User avatar
Wulfman...
Posts: 6688
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: One of my worst nights yet

Post by Wulfman... » Sun Feb 26, 2017 7:40 pm

It appears to me that your pressure is insufficient to deal with your events.
If your events a "positional", try a different position.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

User avatar
palerider
Posts: 32300
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

Re: One of my worst nights yet

Post by palerider » Sun Feb 26, 2017 7:46 pm

RestlessinWoolley wrote:Last night was terrible, i feel like my head was hit by a jackhammer. (VS2 has been disabled as there was 370 events making it impossible to read.) I remember dreaming a ton last night as well as waking up a ton. been resting all afternoon a well, as I have one heck of a headache. I cannot wait to have the new test now as its obvious this isn't working, and raising my pressure seem to further aggravate events, since for some reason, my centrals are not being flagged. I woke up about 430am and tested my Sp02 and it was 86%. March 22nd get here fast please..
you've got your pressure set *WAY* too low, so you've got a ton of obstructives and hypopneas. just what do you *expect*?

raise the pressure. maybe your centrals aren't being flagged because you're not having them!

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

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.

User avatar
RestlessinWoolley
Posts: 158
Joined: Sat Feb 11, 2017 2:03 am
Location: Sedro Woolley, Washington USA

Re: One of my worst nights yet

Post by RestlessinWoolley » Sun Feb 26, 2017 8:00 pm

I'll try again bumping my pressures up, sleep doc wasn't too happy I was experimenting on my own. But now we know the VS2 events are artificial in nature I'll leave auto off and raise pressure a bit see if it changes anything. The hard part is my events change nightly, last night was a 5.9 and the night before a 3.7.

I did finally get a copy of my final report


TEST TYPE:
CPAP titration study

PATIENT DATA/INDICATIONS:
The patient is a 36- year-old man with a history of neurofibromatosis, seizure disorder, chronic pain due to nerve tumors on opioids with chronic insomnia. He has low to no snoring, but gasping, drenching night sweats and low sleep quality. The patient was found to have sleep apnea with an AHI of 12 with predominantly central apneas and slow, irregular breathing pattern with a nadir O2 saturation of 91% on the diagnostic study.

Notable Medications
Morphine 30mg tid, keppra, flexeril


SLEEP SUMMARY/EEG:
The patient had a reduced sleep effiency of 58%, sleeping 252 minutes. Sleep onset was 17 minutes. He had abnormal sleep architecture with 56% stage N1 and 1.4% REM and absent SWS. His sleep was severely disturbed with an arousal index of 32; arousals were due to respiratory events and spontaneous.

RESPIRATORY:
While on PAP, the apnea-hypopnea index (AHI) was 27. There were no obstructive apneas; 42 central apneas were detected. The average oxygen saturation was 96% and there were 4 4% oxygen desaturation events per hour. The lowest oxygen saturation was 86%. Saturations were < 90% for 0.9% of the study period. 22% supine sleep was captured.

CPAP was titrated from 5 to 8 cm of water. In lateral N2 sleep at 6cm, he had few events with a respiratory rate of 7 BPM. He had persistent central apneas in an irregular pattern, many unscored during drowsy wake and prolonged (up to 25 seconds) when CPAP was 7-8cm. He was transitioned to ASV at min EPAP 4, PS min 3, max EPAP 16, max PS 16, auto-rate. He was receiving 20/8 to 14/14 by ASV and had more hypopneas with desaturation. He used the Eson nasal mask with minimal leak.

LIMB MOVEMENTS:
The periodic limb movement index was 0.2 which is normal.

EKG:
The mean heart rate was 85. No arrhythmias were noted.

Subjective:
The patient reported that he slept much better than usual.

INTERPRETATION:
Central sleep apnea due to opioids which is partially treated by the application of CPAP at low pressures, exacerbated by high pressures. He had more events when on ASV mode. Although he has a low respiratory rate, he has no desaturation.

Continued insomnia with sleep fragmentation.

RECOMMENDATIONS:
I will have the patient start CPAP at 6cm and follow-up in clinic to assess efficacy in 4-6 weeks. If this is ineffective, he may need to try bilevel with a back-up rate.


Sleep Summary:
Time at Lights Off
22:35:04
Sleep Onset Latency (SL)
16.9 min.
Time at Lights On
05:50:03
Number of Stage N1 Shifts
72
Total Recording Time (TRT)
435.0 min.
Number of Stage Shifts
160
Sleep Period Time (SPT)
418.1 min.
Number of Awakenings
63
Total Sleep Time (TST)
252.0 min.


Sleep Efficiency (SE)
57.9%
REM Latency
235.5 min.


Oxygen Saturation Summary:

Mean SaO2:
96.1%

Lowest SaO2:
86.0%

Cardiac Summary:

Mean NREM HR:
84.5 bpm
Mean REM HR:
91.6 bpm
Mean TST HR:
84.6 bpm
Highest TST HR:
109.7 bpm
Highest TRT HR:
384.0 bpm

_________________
MachineMask
Additional Comments: Resmed AirCurve 10 ASV
EPAP Min 6, Max 15, PS Min 6, Max 21, BURR 10, Press Max 25, BPM 11, Ti 1.2

"I hate the word 'Handicapped' and 'Disabled'. They imply that you are less than whole don't see myself that way at all". ~Aimee Mullins

User avatar
Julie
Posts: 19898
Joined: Tue Feb 28, 2006 12:58 pm

Re: One of my worst nights yet

Post by Julie » Sun Feb 26, 2017 8:06 pm

Raise your pressure!

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

Re: One of my worst nights yet

Post by Pugsy » Sun Feb 26, 2017 8:24 pm

Per the sleep study report that I saw the original AHI of 12 prior to tx was primarily central apneas.
It never mentioned obstructive apnea really...final diagnosis was central apnea not obstructive apnea.
The patient was found to have sleep apnea with an AHI of 12 with predominantly central apneas and slow, irregular breathing pattern with a nadir O2 saturation of 91% on the diagnostic study.
CPAP was titrated from 5 to 8 cm of water. In lateral N2 sleep at 6cm, he had few events with a respiratory rate of 7 BPM. He had persistent central apneas in an irregular pattern, many unscored during drowsy wake and prolonged (up to 25 seconds) when CPAP was 7-8cm. He was transitioned to ASV at min EPAP 4, PS min 3, max EPAP 16, max PS 16, auto-rate. He was receiving 20/8 to 14/14 by ASV and had more hypopneas with desaturation.
He didn't have any obstructive apneas at the titration study but the centrals were significant and got worse with more pressure.

I know it looks like there are truckloads of obstructive stuff going on per the report above from his machine but it doesn't fly with the diagnostic study or the titration study.
Is the machine having a problem indentifying whatever is going on ???? It's possible.
This is a rather unique situation...centrals most likely from pain medication and maybe confusing the machine.
His doctor is aware that cpap is useless at this pressure for anything. But increasing to treat obstructives reported by the machine may not be the best way to go in this situation. If the machine is wrong and these are mididentified central in nature events instead of obstructive...it ain't going to help and could make things worse if the pressure is increased.
Maybe the machine is wrong is what I am saying. It wouldn't be the first time. It's not common for the machine to make a mistake in labeling events but not impossible especially if his breathing rate is atypical.

Given the history of centrals on the diagnostic study and no real OA and the titration report stating that centrals worsened with more pressure...increasing the pressure to treat whatever these events are is not something I would be wanting to do.
It's already been tried and didn't work.
Given the problem seems to be primarily central and not obstructive...he may end up with AirCurve 10 ASV or maybe the AirCurve 10 ST with back up rate. His doctor prefers ResMed.
The plan is to have another titration devoted to figuring out which specialty machine seems to work best.....that's next month.

I know we all want to help this guy but we can't. This is something that can't be fixed with more pressure using this machine. It just makes things worse.
It's not like he doesn't have a doctor to help him...he's got a doctor who is fully aware of what all is going on.

_________________
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.

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

Re: One of my worst nights yet

Post by Pugsy » Sun Feb 26, 2017 8:31 pm

RestlessinWoolley wrote:I'll try again bumping my pressures up,

Increasing the pressure would only help if you had obstructive sleep apnea and you don't...you have central sleep apnea.
There's no mention of obstructive sleep apneas of any consequence on your diagnostic study.
You don't even appear to have Complex Sleep Apnea (where people have a significant number of both types of apneas).

Increasing pressures in some people will actually cause more centrals to happen..that's why your doctor doesn't want you increasing the pressure. They already tried more during the titration and the result was more centrals (the instability mentioned).

I actually vote for listening to your doctor despite what the machine is saying in your situation.
There's a very real chance the machine is wrong with its labeling...I have personally seen it happen twice.

_________________
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.

User avatar
RestlessinWoolley
Posts: 158
Joined: Sat Feb 11, 2017 2:03 am
Location: Sedro Woolley, Washington USA

Re: One of my worst nights yet

Post by RestlessinWoolley » Sun Feb 26, 2017 8:42 pm

Thanks Pugsy. That's what I was wanting to say without coming off looking like a butt head. I've been fighting this for years now. Heck I originally set up my initial consult in December of 2015 to finally see her in June of 16, and my first test in October and the second in November. She's one of the top sleep doctors in Seattle and isn't happy as well with my numbers. And I did confirm in cases like mine and on Medicare that err to the cheaper machine before having to spend 4x for a high end Bi Level or Asv machine. I'm just face palming because of what Lincare said if I just let them worry about the compliance and if I never found you guys or sleepyhead that I'd of never known about all the flagging. Yet when one night on the dream mapper app i see a 4 AHI and the next a 12 AHI, I really wonder what's going on. This is why i seeked help here to see if anyone else had issues. Granted she specifically put down a Resmed machine because they are far more reliable in her eyes but Lincare could care less as I said I was given a ton of misinformation and wasn't given what I was prescribed.

If this keeps up I may just ask the member for the heated hose as I'm still waking up with a cold soaken wet face as well. It's just one big headache and I still totally stumped on half it other than just waiting till my appt on the 22nd. I could of had an earlier apt but she specifically wanted a late sleeper test in which they only do one night a week as if you were to look over my charts my highest mean Ahi is usually 4-6 am and when the clinic wakes you up at 515 that's right in the middle. My highest AHI in that period has been 47.

I would try different positions of sleep if I could. I have 1000s of tumors on my spine at the nerve roots, the worst at L3-6 more clusters at C2-C5 and thousands more down my sciatic and femoral nerves. I was on over 200 mg of morphine a day at one point till Medicare capped limits at 60 a day. So when I sleep my best pain is a 7/10. I have other means of pain relief but all would contribute to poor breathing. Sleeping on my back is out, unless I land on on in my sleep, my right side seems to be my comfortable side even with all the tumors and my left I can never get comfortable either. I have a sleep number bed set at 80-85 firmer pressures help.

I've got to the point where even driving 30 miles is difficult. My motorcycle has sat 2 years with only a few hundred miles. All my hobbies except my radios have been almost slowed to a stop. Lack of sleep is not fun. And I just had high hopes of putting the mask on and CPAP would be my miracle cure as I've read so many success stories and no real it just didn't work without tons more testing and further sleep loss.

Appreciate everything everyone is trying to do. I'm just still trying to figure out why one night is better and some terrible. And as busy as my doc is she can't drop everything to answer all my questions either.

_________________
MachineMask
Additional Comments: Resmed AirCurve 10 ASV

User avatar
RestlessinWoolley
Posts: 158
Joined: Sat Feb 11, 2017 2:03 am
Location: Sedro Woolley, Washington USA

Re: One of my worst nights yet

Post by RestlessinWoolley » Tue Feb 28, 2017 12:20 pm

Just recieved clarification, direct from my sleep doc, she did confirm that all Clear Airway CA are centrals, and 95% of all the Hypopneas, and pretty much all Obstructive are Central in Nature, Cross loading my data into Encore rebuilt the data differently than Sleep Head. said I have been averaging 30+ Centrals a night. That and shes concerned with my SpO2 levels again, as i have been charting them as well using a borrowed fingertip meter, and shed love to see me wake up with higher than 95% 02 levels. so following the ASV test, I might also have to have oxygen tapped into the airflow as well.. As far as my VS2 events, if the mask change doesn't remedy it, as a mask change seemed to trigger it, and even last night it dropped going back to a medium cushion, that its more than likely picking up noises when I breathe that none of the flags are showing any real snores other than a minute change in airflow, wants me to try something tonight to see if i can get even a better seal, without trimming my whiskers off.. I am also supposed to figure out a decent time this summer to have Stenoplasty done..

Sleepyhead is a good tool, and is generally fairly accurate, but its far from Encore, and another reason she dislikes the Dream Station, its algorithms are far from a ResMed unit. Said if I were to have got the machine she requested, my charts would look far different..

_________________
MachineMask
Additional Comments: Resmed AirCurve 10 ASV
EPAP Min 6, Max 15, PS Min 6, Max 21, BURR 10, Press Max 25, BPM 11, Ti 1.2

"I hate the word 'Handicapped' and 'Disabled'. They imply that you are less than whole don't see myself that way at all". ~Aimee Mullins