A few questions

Hello all,

I'm new to the forum, but have been using CPAP for a little over a year now. My initial sleep study showed the following: (I can go further into depth as necissary, but I'm going to give a summary the best I can).

My study lasted from 21:28 until 02:56.
Wake after sleep onset - 34 minutes
Stage 1 non - REM Sleep - 44 minutes
Stage 2 non - REM Sleep - 221 minutes
Stage 3-4 non - REM Sleep - 0 minutes
REM Sleep - 25 minutes

Total arousals 114. 52 were spontaneous w/index of 10.8/hr. 48 arousals related with respiratory events with respirator arousal index of 9.9/hr. There were 0 respiratory related arousals (RERAs) with REAR index of 0.0/hr.

Anterior tibialis EMG recordings disclosed significant periodic leg movements in sleep. 12.8/hr which caused PLM arousal index of 14.

Significant respiratory abnormalities during sleep w/moderate snoring. 4 episodes of apnea over period and all 4 were obstructive. 86 episodes of hypopena over same time period which yielded a hypopena index of 17.8 events per hour of sleep. Apnea + hypopnea index was 18.6 events per sleepin hour. Disordered breathing events were observed predominantly during REM sleep. Apneas and hyponeas were not more frequent in the supine.

Moderate oxyhemoglobin desaturation. Lowest O2 sat was 87%

Impression - Respiratory events with AHI of 18.6/hr, inducing moderate hypoxemia & moderate disruption of sleep. Also moderate continuous snoring.

I was diagnosed w/Obstructive Sleep Apnea, Moderate, Non-Positional; Hypoxemia, Moderate; Sleep Fragmentation, Moderate; Periodic Limb Movement Disorder; Snoring, Moderate.


My chief complaints before starting CPAP were EXTREME difficult in waking, fatigue during the day, especially when driving - falling asleep while driving. I also complained of overall lack of energy. Since going on CPAP all have improved at least some. My difficulty waking significantly affected my job, as I am a firefighter. I had been late to work 3 times in a period of 2 months, which lead to a 11 hour suspension, even with 2 alarms on my phone, and 3 traditional alarms. I also wasn't waking up to calls at the fire station probably 80% of the time. Since then, I have been late once in 13 months, and wake up to probably 85% of the calls I am supposed to. (All of us sleep through a call occasionally, luckily there are 3 other people in the station, hopefully at least one of us wakes up!) I have felt fatigued while driving maybe 3 times, and usually when being very busy that day, or not sleeping due to the fire department.

I do, however, feel myself going backwards a bit. I have a Philips Respironics REMstar Auto A-Flex machine w/a heated humidifier. I used to achieve an average of 1-2 AHI when I first started, and I am up to a most recent average of 3.8 AHI. I'm feeling a bit more tired again, and am removing my mask for an unknown reason a bit more than normal. I started w/a full mask, and then changed to a different one, with no success. I found a new pharmacy who actually took time to work with me, teach me some things, and showed me I was able to track some of my own data with SleepMapper. They switched me to the Nuance Pro Gel, which for the first 6 months of wear was amazing, and I almost never touched it. It is still very comfortable, but I'm still taking it off twice a week in the middle of the night over the last month.

I come here with the following questions that I hope you guys might be able to help me with.

Is there better software to track my data. (I'm guessing yes since SleepMapper isn't even listed as an option!)

Any thoughts on improving again? My PEEP is currently 7, and I feel throat sort of getting pinched off again, maybe I need some more PEEP?

Anyone have any ideas on what to talk to my doctor about my legs. I get a feeling in my legs that the best way I can describe it is they get "antsy" and I need to straighten them out and clench my leg muscles. To me, it is a feeling that if I were to stick a metal rod in my leg bones it would feel better. This is a VERY strange description, I understand, but it is they best way I can describe the feeling in my legs before bed. This only happens sometimes, but is happening a lot in the last month or two, roughly correlating with my perceived decrease in feeling.

I'm a 5'8", 200 lb male. Moderately active, need to get more active though. I do have diagnosis of Primary Sclerosing Cholangitis, GERD, Hypertension, Allergies, Delayed Gastric Emptying, and Raynaud's Phenomenon, so I've got a few strange medical problems in addition to my sleeping stuff.

Thanks for any suggestions or ideas you all might have. I know this was a lot of info, but I figured it would be easier then adding it later when you asked anyway!

You can use Sleepyhead software or one of Respironics Encore software products.
SleepyHead is free and easy to use...links in my signature line to explain it..how to use and where to get it.
It has a Mac and Windows version.
There is also Encore but no Mac version with it.

What is "PEEP"?

What are your pressure and humidifier settings?
Do you have nasal congestion issues?
Could you be leaking your therapy air out your mouth? (I see you're using a nasal mask) Ever wake up with dry mouth?


Den

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Sorry - my pressure is 7. "PEEP" stands for Positive End Expiratory Pressure, and it's extremely similar to CPAP pressure, and it's what we use on our patient's in the back of an ambulance...

I do have significant nasal congestion, but it is actually greatly improved with my CPAP.

I rarely wake up with dry mouth. I just downloaded and installed SleeyHead software. According to that my average leak rate over the last year is 2.91. My 90% leak rate is 8.00. My percent above leak rate threshold is 2.93%. When I was using SleepMapper, my mask fit was 98-100% all the time, and there was no leak information. I don't feel like it is leaking, and my wife has never mentioned that.

treydawgmt wrote:Sorry - my pressure is 7. "PEEP" stands for Positive End Expiratory Pressure, and it's extremely similar to CPAP pressure, and it's what we use on our patient's in the back of an ambulance...

I do have significant nasal congestion, but it is actually greatly improved with my CPAP.

I rarely wake up with dry mouth. I just downloaded and installed SleeyHead software. According to that my average leak rate over the last year is 2.91. My 90% leak rate is 8.00. My percent above leak rate threshold is 2.93%. When I was using SleepMapper, my mask fit was 98-100% all the time, and there was no leak information. I don't feel like it is leaking, and my wife has never mentioned that.

OK. Got it.

What is your AHI in Sleepyhead?

A pressure of 7 cm. is pretty low. I'm wondering if your therapy is suboptimal for whatever reason(s). We just need to narrow down the possibilities to get it to where it needs to be.
Optimal pressure, eliminate leaks, nasal cleansing, proper humidity levels, etc., etc.


Den

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My Sleepyhead AHI was 2.3-2.8 range for months in the beginning of the year. It is now averaging 3.8 this month. Not a huge increase at all, of course, but I wonder if a higher pressure might help, or something else.

Anyone have ideas on the leg thing at all? Anyone deal with RLS also?

treydawgmt wrote:My Sleepyhead AHI was 2.3-2.8 range for months in the beginning of the year. It is now averaging 3.8 this month. Not a huge increase at all, of course, but I wonder if a higher pressure might help, or something else.

Anyone have ideas on the leg thing at all? Anyone deal with RLS also?

I would think so. Try it and see.

Lots of people on the forum have or have discussed RLS over the years.
My wife's doctor prescribed that she take some OTC Iron vitamins (65 mg.) and that seemed to have helped her. She's not on this therapy, but has believed she has had some RLS from time to time.


Den

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