Suggestions? First posting screen shot from Sleepyhead

FrozenmamaBC · Post by **FrozenmamaBC** » Fri Feb 16, 2018 6:32 pm

I hope that screen grab works. I wasn't able to minimize (remove) the pie chart, but do hope I managed to capture some relevant information.

I am currently trying out a loaner machine. Resmed For Her. Initially, it was set to auto, and then the company put it to cpap, with a pressure of 12. I have been through many masks. Started with nasal ones, but progressed to FF due to issues with my sinuses. I was just given a Fisher Paykel Simplus to try out - and while I don't dislike it, my AHI numbers have been going up and up each night. Last night being the worst, at just over 8. Thanks to the software, it said I spent over 10 mins in apnea last night. Also, since I first started, I have seen my AHI as low at .94 - but that was with a nasal mask, weeks ago.

I am trying not to feel frustrated - my AHI is way down from using no treatment, and there are clinical signs of improvement - but is this as good as it could get? Is there something we can do to improve on that?

Thanks everyone. This forum is a wonderful resource for someone new to all of this.

Pugsy · Post by **Pugsy** » Fri Feb 16, 2018 6:48 pm

Can you grab a quick image of the Flow Limitation graph also please?
For this same night.

Do you happen to know if your OSA is worse on your back or in REM sleep?
Any chance you were on your back between 00:20 to approx 1:00?

FrozenmamaBC · Post by **FrozenmamaBC** » Fri Feb 16, 2018 6:58 pm

Being on my back is totally possible. It isn't my preferred sleeping position (side sleeper), but you never know.

Last night I felt like I had a strange sleep - kept popping awake, feeling really alert. Don't know if that is relevant - just noting what happened.

Pugsy · Post by **Pugsy** » Fri Feb 16, 2018 7:26 pm

It's common for our OSA to be worse in REM or when on our backs...and it is common to need more pressure when on our backs or in REM.
Yours could be either. The first REM stage usually comes on about 90 minutes or so after sleep onset. So that first ugly cluster might be REM related or supine related or maybe a combination of both.

It is also common to need more pressure when using a full face mask over a nasal mask. Maybe it's because of the way the full face mask seems to alter airway position ever so slightly with that lower strap pulling the jaw back just a little. I don't know for sure why...only that I have seen it happen often enough to know it can happen.

It's obvious your fixed pressure wasn't able to do the job of holding the airway open well enough.
The flow limitation graph is especially active at the same time of the hyponea cluster...so just confirms what I suspected.

There are times in the night when the pressure of 12 fixed does a good job and some other times it doesn't do such a good job.
You can see the flow limitations increase about the same time as the other event flags but of course worse with the first cluster and that first cluster is the biggie for causing your AHI to be elevated. As to why you needed more pressure...dunno for sure. It's going to be either supine sleeping or REM relate or maybe on your back during REM.
How much more we don't don't know and this is where an auto adjusting mode (apap) would be helpful.

Is this just a trial of a machine to try to get your pressures dialed in and they are going to swap out the machine for a permanent machine later?
Your data makes a good argument for getting a machine that offers apap mode as a permanent machine to use.
Otherwise you are going to have to use more pressure all night to prevent those ugly clusters at least when using a full face mask.
While not the end of the world to use fixed all night...you might be like me and need 18 cm for whatever is causing those clusters and I can tell you that 18 all night isn't much fun. I much prefer to use 18 only when needed (mine is REM related).

ChicagoGranny · Post by **ChicagoGranny** » Fri Feb 16, 2018 7:38 pm

FrozenmamaBC wrote: ↑
Fri Feb 16, 2018 6:32 pm
Initially, it was set to auto

Can you post a screenshot of an auto night where you felt like you slept the best (or least bad)?

FrozenmamaBC · Post by **FrozenmamaBC** » Fri Feb 16, 2018 8:22 pm

My provider said that although I am being loaned the fancy machine with variable pressure, that I don't need it. When it comes time to buy (next week) that a basic cpap will do.

Her logic is that due to the many central apneas detected in my inital testing, that the auto cpap would allow my brain to become "lazy and not work properly, creating more apneas."

That sounded like bologna to me - but what do I know?

My insurance will cover the bulk of the cost of the equipment, so I might just ask to buy the one with variable pressure and tweak my settings with the help of this group. Honestly, I sometimes feel like my equipment provider doesn't really know what's up, or look at the data coming out of the machine

For example, when I went in this week, they proclaimed "everything looks great!", when I know from Sleepyhead - the data is not great. Granted, going from untreated 40 events per hour, to 8 is a huge step in the right direction, but I think it can be better.

Pugsy · Post by **Pugsy** » Fri Feb 16, 2018 8:35 pm

FrozenmamaBC wrote: ↑
Fri Feb 16, 2018 8:22 pm
Her logic is that due to the many central apneas detected in my inital testing, that the auto cpap would allow my brain to become "lazy and not work properly, creating more apneas."

That sounded like bologna to me - but what do I know?

Well.....sounds like a load of bull crap to me.

Can you please post a night when you used apap mode...pick a good night and a bad night in terms of AHI?

Julie · Post by **Julie** » Fri Feb 16, 2018 8:37 pm

Julie · Post by **Julie** » Fri Feb 16, 2018 8:38 pm

Definitely bologna! And the insce. codes for Apap and Cpap are the same as far as the company's are concerned so that can't be an issue. Hold out for what you want.

FrozenmamaBC · Post by **FrozenmamaBC** » Fri Feb 16, 2018 8:43 pm

Here are two screen shots from when I was set to auto. The AVI were lower, with pressures as high as 15. I don't really feel like any of my sleeps have been better than the other so I just included two days from the week that I was auto.

Pugsy · Post by **Pugsy** » Fri Feb 16, 2018 8:51 pm

Well I see where she came up with 12 fixed....it's the 95% pressure and all that means is at or below but often these yahoos choose to use it for fixed. They are ignoring the other 5% of the time when it goes higher.
Were these with apap with the nasal mask or the full face mask?
How early in your therapy were these 2 nights?
Those centrals may or may not have even been real and even if they were all real there's not enough of them to worry about.

We can make fixed pressure work for you...it will involve maybe using more fixed pressure and/or turning EPR down or off.

LSAT · Post by **LSAT** » Fri Feb 16, 2018 9:09 pm

FrozenmamaBC wrote: ↑
Fri Feb 16, 2018 8:22 pm
My provider said that although I am being loaned the fancy machine with variable pressure, that I don't need it. When it comes time to buy (next week) that a basic cpap will do.

Her logic is that due to the many central apneas detected in my inital testing, that the auto cpap would allow my brain to become "lazy and not work properly, creating more apneas."

That sounded like bologna to me - but what do I know? That's worse than bologna...it's BS

My insurance will cover the bulk of the cost of the equipment, so I might just ask to buy the one with variable pressure and tweak my settings with the help of this group. Honestly, I sometimes feel like my equipment provider doesn't really know what's up, or look at the data coming out of the machine

For example, when I went in this week, they proclaimed "everything looks great!", when I know from Sleepyhead - the data is not great. Granted, going from untreated 40 events per hour, to 8 is a huge step in the right direction, but I think it can be better.

Don't let them talk you into a fixed pressure machine...You want an autoset. Either Resmed Airsense Autoset or Respironics Dreamstation Auto

FrozenmamaBC · Post by **FrozenmamaBC** » Fri Feb 16, 2018 9:14 pm

These two nights were in the first week of cpap. It was with the nasal mask.

My EPR is set to 2, so that could easily be adjusted.

Pugsy · Post by **Pugsy** » Fri Feb 16, 2018 9:20 pm

How about coming over to the dark side and setting the machine back to auto mode tonight and see what the machine wants to do with a full face mask?

Don't know how? It's easy.
See the manual as it explains how to get into the clinical setup mode and change things.
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Just one night and see what happens.

The first week of cpap therapy people typically get a lot more "centrals" because they simply don't sleep so great with all this new stuff attached to use.
And remember...it's normal to have a sleep onset central when transitioning to sleep anyway. It's not bad unless you have a truckload of them and you were no where near truckload numbers.

FrozenmamaBC · Post by **FrozenmamaBC** » Fri Feb 16, 2018 9:38 pm

Pugsy:

Am I allowed to mess with the settings while it is a loaner machine? I feel like I might get in trouble from my provider!

I havent even told them that I look on Sleepyhead. I don't know how to describe it - it is almost like they dont want people to be involved in their care. Just "Do as we say".

Suggestions? First posting screen shot from Sleepyhead

Suggestions? First posting screen shot from Sleepyhead

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