Frustrated newby questions

Hello,
I am new to CPAP and the forum. I have spent several days navigating the forum posts and have learned a great deal already. Thank you for providing support to new users who are bewildered by this life changing event. Perhaps someone can provide answers to some of my concerns.

I was diagnosed with OSA on February 11, 2016, in a very brief conference with the sleep doc who read my study (no review of specific data, nor release of study results). I subsequently requested and received my report. I spent 107 minutes in diagnostic sleep, resulting in 2 respiratory arousals, and 1 snore arousal. The remaining arousals were from PLM (6) and spontaneous (23). I experienced 22 respiratory disturbance events during diagnostic sleep, 16 hypopnea in non-rem sleep and 6 in rem sleep. I experienced no apneas in diagnostic sleep.

I spent 291 minutes in therapeutic sleep with CPAP, using a Pico nasal mask, and a ResMed chin strap. Therapeutic sleep yielded 1 respiratory arousal (a central apnea), 18 PLM arousals and 14 spontaneous arousals. I experienced 1 respiratory disturbance event during therapeutic sleep, a central apnea, and 0 hypopneas in non-rem sleep and 0 in rem sleep. So CPAP therapy did appear to be beneficial in alleviating the hypopneas.

Although by far the greatest number of arousals in both diagnostic and therapeutic sleep were from PLM or were spontaneous (61), the 22 respiratory disturbance events in diagnostic sleep accounted for only 2 respiratory arousals; so the remaining 20 respiratory disturbances must have been rather minor, but did serve to skew the Respiratory Disturbance Index (RDI) to 12.3.

My resulting Medicare AHI was 12.3; and findings of : snorer (1 arousal); OSA (0 obstructive apneas, 1 central apnea) and PLM (which appeared to be valid based on the data), with a corresponding RDI of 12.3.

CPAP therapy was recommended to address my “awakening approximately every five minutes” to quote the sleep doc. I was prescribed a Phillips Respironics Dream Station Auto CPAP with humidifier, set to 6-8 cmH2O pressure. As I had used a Phillips Pico nasal mask during the study, that and a ResMed chin strap were also prescribed.

I have installed Phillips DreamMapper software App on my phone and review the usage, mask fit, and AHI data each morning for the previous night’s sleep. I have received therapy for an average of 7+ hours for each of the 21 nights that I have had the equipment.

My AHI data have been troubling since I began therapy. My highest AHI, as measured only by Phillips DreamMapper app, has been 25 and has averaged in the mid to low teens since inception of therapy. My lowest AHI has been 10, but only once. There has been little to no perceptible reduction in AHI value since therapy began. A week after initial prescription, I returned to the DME who had prescribed my Pico mask to discuss issues with dry mouth, mouth leaks/ mouth breathing despite use of the chin strap. I was prescribed a ResMed Mirage Quattro FF mask. I have used it consistently since February 23, 2016. I have had significant issues with discomfort, leaks, and frequent awakenings to address leaks/comfort. I am experiencing nose bridge sensitivity/redness and discomfort after mask removalI. I have applied a homemade mask liner, which has reduced leakage somewhat, and has also increased mask comfort. I just received a Pad-a-Cheek liner and pad for the Quattro which I used on 3/2. Initially there were some cheek leaks, so I added the homemade liner to it. Mask fit was 100% for the night, and my AHI was the lowest it has been since therapy began at 11.

My sleep quality has felt far worse than untreated sleep, and the degree of day time sleepiness is far greater now. I am irritable and have no interest is the active lifestyle I enjoyed before experiencing sleep deprivation.

I am approximately ten pounds over weight @(165lbs) for the past four months; I try to carry 155 pounds normally, but due to winter temps I have lately been running less that normal. I am 5’9” tall. I am 67 years old. I have coronary artery disease and had a double coronary bypass in 1993, without issues thereafter. I am followed by my cardiologist regularly, but he has never questioned, nor addressed any sleep quality issues. I was referred for a sleep study by an allergist who follows me for GERD.

My questions are:
1. How accurate are the data from the DreamStation, as reflected only by the Phillips DreamMapper app, as compared to that from the sleep study? I have grave concerns about the limited accuracy on which I must base the efficacy of CPAP therapy. While I did have 22 hypopneas in diagnostic sleep; none were evident during therapeutic (CPAP) sleep. I had only one central apnea observed in therapeutic sleep, yet the DreamMapper data reports daily occurrences of clear apneas, numerous obstructive apneas daily, and numerous hypopneas daily. My currently reported DreamMapper AHI is steady in the mid to low teens, while my (Medicare AHI) was reported to be 12.3 during diagnostic/ therapeutic sleep. What am I to conclude from these disparities in data?

2. Since I have been able to rely only on the DreamMapper app for sleep quality data due to having a Phillips DreamStation CPAP auto for which there is no edition of Sleepy Head yet; and because I am an Apple user and Phillips Encore is only available to MicroSoft users, I get very limited sleep data feedback. I am aware there is an Apple edition of Sleepy Head, but the comments by the SH developer did not sound very encouraging about it’s use. Can anyone give me advice about a workaround to enable use of SleepyHead on my Apple MacBook?

I am committed to making CPAP therapy work, given my cardiac history, but until the last couple of nights when sleep quality has been a bit better, I have been very discouraged. I have an appointment tomorrow to try out an Amara View mask. Perhaps it will alleviate the nose bridge issues with the Quattro.

Sorry for the rambling post. Any recommendations would be greatly appreciated.
augustsilverbear

I have an iMac and long ago used Boot Camp through the Intel side of things to use Encore... or can you not do that for some reason?

augustsilverbear wrote:
1. How accurate are the data from the DreamStation, as reflected only by the Phillips DreamMapper app, as compared to that from the sleep study? I have grave concerns about the limited accuracy on which I must base the efficacy of CPAP therapy. While I did have 22 hypopneas in diagnostic sleep; none were evident during therapeutic (CPAP) sleep. I had only one central apnea observed in therapeutic sleep, yet the DreamMapper data reports daily occurrences of clear apneas, numerous obstructive apneas daily, and numerous hypopneas daily. My currently reported DreamMapper AHI is steady in the mid to low teens, while my (Medicare AHI) was reported to be 12.3 during diagnostic/ therapeutic sleep. What am I to conclude from these disparities in data?

First, the data shown in DreamMapper is as accurate as the data recorded by your PR Dreamstation. More on that in a bit. The data shown in DreamMapper, however, is only a small part of the overall data that your Dreamstation records each night. Looking at the data in Encore would provide a fuller, richer picture of what your Dreamstation thinks is happening each night.

Now for your real questions: How accurate is the data and why is there a disparity between the nightly data recorded by the CPAP and the data that was recorded during the sleep study?

First, nothing is going to be as accurate as an in-lab sleep study with all the wires and belts. The tech has multiple channels of data to look at each and every time your breathing becomes irregular or excessively shallow. If the EEG indicates you are not asleep, the "event" is assumed to be a natural part of the variation in wake breathing. And that's true even if the wake is very, very short. Many people actually wake up every time they turn over in bed for example, and it's not uncommon to (unconsciously) hold your breath while you are concentrating on turning over. If a breathing irregularity is determined to be sleep disordered breathing, there is plenty of data from the belts to determine whether the event is central or obstructive in its nature. But here's the thing to keep in mind about lab data: It's recorded in an artificial setting, so you may not sleep as long or as deeply as you would in your own bed. You may have fewer REM cycles. You may have more spontaneous arousals or wakes caused by just being in a strange place with all these wires all over you. And our sleep apnea can also vary a bit from night to night. In other words, some nights our airway may have more of a tendency to collapse than usual and some nights our airway may have less of a tendency to collapse than usual.

So the in-lab study captures a very detailed picture of what our sleep disordered breathing (and its reaction to CPAP) looks like on one particular night.

Now let's look at what the Dreamstation can actually do every night in your own home. The Dreamstation has only one data channel to look at: Air flow into/out of your lungs. The Dreamstation has no EEG data. So it cannot definitively tell when you are awake; it cannot definitively tell when you are asleep, and it cannot definitively tell when you've had an arousal. But it can use the air flow and the back pressure in the tube to very precisely measure the rate air is going into and out of your lungs. And hence it can determine quite accurately when the air flow into/out of your lungs decreases significantly from the running baseline for 10 seconds or more. And when that happens, the machine scores an event---either a hypopnea or an apnea. If the event is an apnea, the machine does a "pressure pulse" test that uses the back pressure to determine with a reasonable degree of accuracy whether your airway is clear or obstructed.

Now if you spend a lot of time tossing and turning and drifting in and out of light sleep at home while using your CPAP, there may be a lot of events that are recorded as hypopneas or apneas that would NOT be scored in the lab. That's why we often ask people about how restless they were when they post data with a particularly nasty cluster of events.

On the other hand, if you slept very little during the in-lab titration test, that test may not have given the tech enough sleep to properly titrate you. For example, if you had very little REM sleep during the titration, but your OSA is much higher in REM than non-REM (which is common), then the pressure setting established by the lab may be low enough to allow a lot of events to happen during your REM cycles at home in your bed. Same thing with back sleeping: If you didn't sleep much on your back in the titration test and your OSA has a strong positional component to it, then if/when you start back sleeping at home, a lot of events can get by the CPAP defenses and be recorded by your CPAP machine.

So the most important thing about the data your CPAP records each night is that it gives a good indication over time whether CPAP is doing its job in treating the OSA. Most of us have "bad" nights now and then where our machine AHI is higher than we'd like it to be. But if those nights are relatively few and far apart, we don't need to worry about them. Some of us who have been PAPing for months or years can pick up some long term trends in our data that can be explained by other things in our health. (For example, I can often tell I'm coming down with a headcold a day or two before the symptoms start because there will be a pretty significant jump in my AHI from the 1.5-3.0 range to the 4.5+ area.) But if there's a long term trend of higher than expected AHI's, that's an issue. For a new CPAPer, if the AHI doesn't settle down to the "< 5" range in a week or two of starting PAP, it's worth calling the sleep doc's office and reporting the issue.

Without seeing the data (even the DreamMapper version of it), I really can't speculate on what the discrepancy means in your case.

2. Since I have been able to rely only on the DreamMapper app for sleep quality data due to having a Phillips DreamStation CPAP auto for which there is no edition of Sleepy Head yet; and because I am an Apple user and Phillips Encore is only available to MicroSoft users, I get very limited sleep data feedback. I am aware there is an Apple edition of Sleepy Head, but the comments by the SH developer did not sound very encouraging about it’s use. Can anyone give me advice about a workaround to enable use of SleepyHead on my Apple MacBook?

JediMark and others are working on this. I think they're getting close. You could help if you want by zipping your data together and dropping it off in the appropriate dropbox in this thread: viewtopic.php?f=1&t=110649&p=1060984&h#p1060815

Thanks robysue, for your commentary. I appreciate your taking the time to explain why my event total in diagnostic/therapeutic sleep may differ from what is reflected by Dreammapper.

Re: Encore usage with my DreamStation device while waiting for access to Sleepyhead, which Encore product is most widely used by forum members? I see references to several in posts and find Encore Anywhere and Encore Pro on the Phillips Respironics website. I assume anyone can download and use it, not just clinicians and physicians?
augustsilverbear

Anyone. Most doctors wouldn't know what they were looking at anyhow!

Thanks, Julie.
augustsilverbear

My cpac machine has water in the breathing hose and the face mask makes noise something is not right.

Guest wrote:My cpac machine has water in the breathing hose and the face mask makes noise something is not right.

Condensation in the hose and/or mask...commonly called "rain out".

You might start a thread of your own and include exactly which brand and model machine you have because some machines have some optional features to help reduce rain out.
Otherwise I think I covered pretty much all your options in this thread...see my posts number 2 & 3 for you options to try.
viewtopic/t94035/Pugsys-Pointers-3Deali ... -road.html

Easiest fix...
If you are already using a heated hose...increase the hose air temp.
If you aren't using a heated hose and your machine is heated hose capable...get one.

If heated hose is not an option or you don't want one you can try a hose cozy or lowering the machine and hope gravity helps you out.

All this and other options explained in the above thread.

Make sure your machine's located at a slightly lower level (by a couple of inches) than you are so water will run back to it and not to you.