First Night With VPAP Machine

Hi All,

Tonight's my first night trying a machine and already I owe some real positive things to you all here.
Some background: My Drs sent me for a sleep study even though the did not suspect apnea (underweight, no snoring, no apneas observed.....just severe insomnia for 15 years)

First study
Study showed moderate to severe central apnea and some OSA and mixed (83 Central in mean 12.6secs and maximum 17 secs) * obstructive mean 17.1 and max 31.4. * mixed 28 mean and 36,8 max) ]


Wake after sleep offset 146.0min 35%
Stage N1 88 mins 21.1%
Stage N2 116 27.9%
Stage N3 265.Min 6.3%
REM 10 min 2.3%

Sleep Efficiency 57.7%
60.5 arusals per per hour of sleep - damn! one a minute!
32.4 leg movements per hours of sleep, too.

Sleeping SaO2% range 80.0-88.0 < this was the scary part.

During one 5 minute sample:
Central Apneas: 83 (mean 12.9 secs, max 17.6) SaO2% range 87-93
Obstructive: 8 (17.1secs mean, 31.4 max) SaO2% Range 81-92
Mixed 8 (18.4 mean, 49.9mac) saO2% Range88-93

Had no time to try a mask that night. Went back 2 weeks later. They used VPAP mask all night since primarily central apnea. The results were great:

Second Study
Wake after sleep offset 50.0min 11.3%
Stage N1 54,5 mins 12.3%
Stage N2 235.5 57.4%
Stage N3 0.Min 0%
REM 54 min 12.2%

Sleep efficiency: 81.9%

Doc says I have idiopathic central sleep apnea. I'm game to begin treatment, but I want to pursue findings out why my brain doesn't tell my lungs to breath. WTF is *that*?????

Meanwhile, DME brought a CPAP on Wednesday. I sent her off, called the doc, and got Resmed VPAP Auto today. Need to get a reslink next week. I did hack around and find the clinicians menu, so I can see some stats in the morning.


I'll keep you posted! Thanks so much for posting machine info here, I would never have known to question the first machine!!

peace,
john

Good mini-rant, John.

Welcome to the forum. And to the chatroom!

Hi John, I joined recently also. I found my first material about central sleep apnea under 'sleep apnea' on Wikipedia. I stumbled across here later. Its a shock to find out your brain is failing to tell your lungs to breath.

Good morning!

Well. I woke up with no mask on my face.
I recall being comfortable with the maask and don't recall being awake through the night.
I woke up at 9, about 8 hours after lights out.

Do not recall removing the mask.

THe little bit of information I can get from the machine:

LEAK: 0L/min
AHI: 9.3
AI: 3.5
Avg Press: 8.2
VT: 235-731
RESP RATE: 12-15
MV: 3-9
USage: 4:49 hours


Most of these numbers appear they will become averages over time. Should I erase this data before going to sleep tonight so I get just one day again?

Am I correct that getting reslink is my best way to get data out of this thing ongoing? Or, is there a cable that can go to a PC/MAC?

Any insights about these numbers?

Most important: I feel like I slept!!!


THanks!!
John

john.michael,

A hearty welcome to the forum.

And a sad welcome to the xPAP & insomnia club.

You say you've had severe insomnia for 15 years. The untreated apnea may well have contributed to that insomnia, but it may not be the only thing that's been feeding the insomnia. And you really won't feel the full benefit of using your new VPAP machine if the insomnia continues to plague your OR if it happens to get worse during the time you are adjusting to therapy.

Learn to check the on-board data which is very good on the ResMed machines. Keep track of the overnight AHI and CAI numbers on paper until you locate the needed card reader to download the detailed data into ResScan. Seeing good, low AHI and CAI numbers may very well help keep you committed to making therapy work if you hit problems in general and problems with the insomnia in particular.

In my case, starting xPAP triggered a really severe bout of insomia. I've seen that you've read my response in Reluctant to Sleep. You might also want to look at my responses in No Results.

SInce you have the long history of insomnia, I'd strongly advice you to monitor your insomnia symptoms as well as the quality of treatment the VPAP is providing. If the insomnia WORSENS during your adjustment period, do report it to your sleep doctor's office and ask to speak to a nurse, a PA, or a doctor about what kinds of things you can and should be doing to minimize the insomnia. If the VPAP + insomnia combo starts to really interfere with your life in the sense of making you feel worse instead of better, call the doctor's office right away and tell them that you need help in keeping the insomnia under control so that you can get used to using the machine.

You will need to decide whether you are willing to take sleeping pills or not (I am not.) It's a personal decision and what's right for me may not be right for you. Many folks on the forum have found sleeping pills useful.

If you do decide to take pills, be sure to talk to the doctor/PA/nurse about 1) how long you and they expect you to keep taking the pills and 2) how to wean yourself off the pills when it is time to discontinue them.

If you decide you want a non-drug based approach to dealing with the insomnia, the start by doing serious work on your sleep hygiene and be prepared to undergo some intentional sleep deprivation (in the form of a sleep restricted schedule) in necessary.

john.michael wrote:Good morning!

Well. I woke up with no mask on my face.
I recall being comfortable with the maask and don't recall being awake through the night.
I woke up at 9, about 8 hours after lights out.

Do not recall removing the mask.

Lots of folks take the mask off in their sleep at the beginning. Don't beat yourself up too much about this. But also if it persists, searching for "taking mask off in sleep" and posting in a new thread with a title like that. Be sure to include what mask your are using in the title.

And if you find yourself awake in the middle of the night without the mask on, calmly put it back on and try to get back to sleep. Again, don't beat yourself up about taking it off in your sleep.

THe little bit of information I can get from the machine:

LEAK: 0L/min
AHI: 9.3
AI: 3.5
Avg Press: 8.2
VT: 235-731
RESP RATE: 12-15
MV: 3-9
USage: 4:49 hours


Most of these numbers appear they will become averages over time. Should I erase this data before going to sleep tonight so I get just one day again?

I believe that on the S8-based VPAP you can choose the time frame for the sleep quality report. (I know you can on the S9 AutoSet.) So check to see if those numbers are 1-day numbers, 7-day numbers, or longer periods of time. The 1-day figures on the S9 would automatically reset at noon so you didn't have to "erase" them. I believe that the S8's are similar.

john.michael wrote:Good morning!

Well. I woke up with no mask on my face.
I recall being comfortable with the maask and don't recall being awake through the night.
I woke up at 9, about 8 hours after lights out.

Do not recall removing the mask.

As robysue said, that happens to quite a few people in the early days (well, nights) of getting used to CPAP treatment.

john.michael wrote:Most important: I feel like I slept!!!

Very good start!

Hi again,

Thanks to each of you for kind and helpful replies.

Here's a quick update on nights 2 & 3:
Night 2 was Saturday night. I went out of town with my wife to meet some friends and see a concert.
We shared a hotel room with the other couple, and I brought my machine anyway.
I got in bed with it, and it seemed OK in that it was quiet, and I wasn't embarassed or anything.
However, it felt like I couldn't breath.
I decided to re-do the "learn circuit"
Multiple times, that ended with "INVALID CIRCUIT"
Eventually, I tried it with the mask off the hose. That ended with the expected "Circuit Learned Successfully"
I went back to trying it with the mask, checking carefully that the mask appeared normal and unobstructed.
Same thing, "INVALID CIRCUIT"
I turned off the machine and was kept awake by the snoring of the other guty in the room!

In the morning, I tried again, and after the 2nd try got "Circuit Learned Successfully" with the mask in place.

Night 3:
Night 3 was last night, Sunday.
After we got home, I re-assembled the machine and did "Learn Circuit"
First try, "INVALID CIRCUIT"
Second try, "Circuit Learned Successfully"
I took 10mg Ambien and began therapy 15 minutes later.
My wife woke me 9 hours later.
I felt moderately rested. It was fairly difficult to get up, but not terrible.
Again, the mask was on the floor. I do not recall removing it.
My wife said I seemed comfortable as she was going to sleep. I had the mask on, and adjusted my position from on my side, on my back, etc "freely"
The machine readout:

LEAK: 0L/min
AHI: 5.0
AI: 1.1
Avg Press: 8.2
VT: 321-662
RESP RATE: 12-15
MV: 4-9
Usage: 4:11 hours

I can see how the daiy numbers reset, and as suggested, there is no need to erase anything.


Mr Bill: Thanks for your reply. I, too, read things like wiwkipedia first. And, yes, it was (and still is) a major shock the my brain is not 'telling' my lungs to breathe! I am seeing my GP this afternoon since he recently received the reports from sleep doctors.

Robysue: Thanks for your kind words about removing the mask, and all the comments, info, and insight about insomnia. I will definitely read the threads you recommended. As you see listed above, I did use Ambien last night. I am (therefore obviously) not 100% opposed to sleeping pills. I have a lot of experience with them. I stopped using them last December, before my first sleep study, after weaning off during 3 months of sleep hygiene work. My sleep doctor has recommended I use Ambien at the beginning of adjusting to VPAP.

Thanks for all the encouragement, rested gal!


I am hoping the rest of the nights this week will bring progress. I have no travel planned, and see no barriers to good sleep hygiene.

I am wondering whether I should approach my sleep doctor or the DME about getting the adapter and software for better data capture. I'm leaning towards the Dr.......

Thanks again everyone!
-John

I take my mask off frequently. In fact last night was my first decent sleep in 4 days. I got 3 and 1.5 and 1.5 hours of ASV time per night up till last night when I managed to keep it on most of the night and got 7 hours.

The 'calibration' sounds odd. You have one of the types that measures pressures with a second tube along the hose, right? The Respironics design just uses the one tube. I don't have enough experience to judge if one is better than the other.

Do get the software. You will find yourself quickly drawing correlations between what the machine saw over night and what you remember from the night or feel the next morning. Having in your head, what is going on is very satisfying and probably contributes to better therapy.

Last night (Monday) was night 4.

The mask stayed on all night!

LEAK: 0L/min
AHI: 3.7
AI: 1.1
Avg Press: 8.6
VT: 291-736
RESP RATE: 12-15
MV: 3-9
Usage: 6:06 hours


I wanted to sleep longer, but it was no where near as hard to get up as it is on many days. I'm guessing (hoping) that is because my blood oxygen level didn't go as low as before treatment. I mean, no Dr has told me this yet, but I have to imagine 80-83 blood oxygen level makes it pretty hard to get up with a clear head.

I found the posts about using null model serial cable with resscan software. Can hopefully try that in a few days.

Further good news is I am actually tired right now. Going to put computer down and try to sleep. Can't remember the last time I wanted to sleep before midnight!

I'll keep y'all posted......

Peace, John

Since you have the H3i humidifier I am assuming the Adapt SV is an S8. The S8 ResLink is no longer being manufactured and is very difficult to find and VERY EXPENSIVE. If it is the oximeter you want w/it, it gets even more expensive! If I remember correctly we are talking somewhere in the realm of $800-$900.

I get the impression from some of what you say that maybe when you say ResLink you actually mean the Resmed software, ResScan. If it is the software, ResScan, check Uncle_Bob's posts here for information on obtaining it.

That still leaves you w/the problem of obtaining the necessary cable reader. That is getting harder and harder to find altho someone recentlyl posted here some place that was still selling them. I just don't remember who or the thread it was in.

And since the S8s are being replaced you would also do well to buy a couple of extra S8 data cards whilst they are still available.

And if it IS the S8 ResLink that you want AND you do manage to find one - be sure to buy a couple of extra data cards for it too.

Good luck!!!!

Slinky wrote: That still leaves you w/the problem of obtaining the necessary cable reader. That is getting harder and harder to find altho someone recentlyl posted here some place that was still selling them. I just don't remember who or the thread it was in.

I found it on Ebay starting bid $75 no bid, ends in a little over an hour but I bet it gets relisted.

http://cgi.ebay.com/Resmed-ResScan-Smar ... 230e897306

Only place I have found it at. At any price. All other google hits "no longer carried"

Gads. maybe I wasn't clear: the cable reader isn't needed to use the S8 PAP, but it IS needed to upload the data from the data card to your 'puter. (I thought I'd better clarify that as I didn't want to mislead anyone).

I'm NOT trying to talk anyone out of an S8! The S8s are a GREAT series of PAPs, other than the Compact and Escape which can't produce any worthwhile data but do provide good basic therapy. The S8s are sturdy, durable and reliable. Whether the S9s can uphold the quality of care, therapy and reliability of the S8s ..... the story is still out on those issues. The S9s still need to prove themselves and only time can do that.

I suspect the Resmed S8 series may well be one of Resmed's stellar devices just as Respironics' Legacy series were PR's stellar devices. Both series hard acts to follow.

UH OH, it looks like I caused some confusion!
After reading the last couple of messages (thanks Pugsy & slinky!), I checked and found I listed the wrong humidifier. My machine is definitely Resmed Adapt SV Enhanced. The humidifier is 2i, not 3 as I listed before. I'm really sorry about the confusion and causing the thought that I might actually have an S8.
I updated my machine info...

By the way, I have not tried the humidifer yet. I think I am comfortable without it so far.

I also read a bunch of posts about the ResScan software and using it with a null modem cable. Also that ResLink is not easily available, but apparently not needed if I use the PC and cable. I do have a laptop with Windows XP and a serial port, so I will try that in a few days when I get a serial null modem cable.


In the meantime, here is what happened last night/this morning:
Night 5:

LEAK: 0L/min
AHI: 8.0
AI: 2.2
Avg Press: 8.4
VT: 283-724
RESP RATE: 12-15
MV: 4-9
Usage: 5:53 hours

Went to bed about 11:30pm, 10mg ambien again. Woke up with mask on at 2am, and went right back to sleep. Woke up again about 5:30, again with mask on. TRied to go back to sleep, but got uncomfortable with the mask after 15-20 minutes. Removed the mask, dozed for a while, and then put the mask back on and slept until about 8.

I feel like I'm making pretty good progress. Concern from last night is that AHI went back up to 8 after being much lower the night before. I am definitely curious to see detailed data.....

-John

White_Beard at apneasupport.com is an experienced user of the Adapt SV Enhanced and is VERY, VERY pleased w/it. You might want to drop in there and PM him. He's a great guy and always glad to help out. And for those of you men who have a beard - White_Beard has a magnificent white "Santa Claus" beard and still is successful w/PAP therapy!!!