Grim first night

[yarrow]

Diagnosed with AHI of 20.4; given an S9 Autoset in CPAP mode with a pressure of 9 cm; resulting AHI of 14.6, mostly "Clear Airway" which I see from searching here means "the machine's best guess is this is a central apnea event". Some fairly clear times but also an hour of 30 AHI with twenty minute periods of up to 75.

(The missing times in the SleepyHead graphs below are me up and about rather than sleeping with mask off).

Any suggestions?

[Pugsy]

Do you have copies of your sleep studies? The initial diagnostic study as well as the titration study? If not...get them.

First night's can be rough. If you have done some reading you may be aware that some of those "centrals" might be scored while you are awake. If your sleep was highly fragmented last night due to the alien being stuck on your face then we perhaps can explain away some of those "centrals".

Nothing you can do right now except watch them and get adjusted to sleeping with the mask and machine. See if the centrals reduce. Make plans to talk to your doctor about them especially if you had any centrals mentioned very much in your sleep studies.

You don't want or need to adjust the pressure.

Work on leaks...some of them are bigger than we would like to see but for a first night the bulk of the night the leak was below 24 L/min...large leak territory. If you look at the large leak (4:45 or so) at the same time as the cluster of obstructive events..probably the leak allowed a few events to sneak past the defenses because the leak cause the pressure delivered to be less than optimal.

At this point the centrals are the concern right now. Not much you can do at this point about them. Give it some time to see if they reduce...they may if your sleepy was highly fragmented with a lot of awakenings last night.
If they don't..need to talk to your doctor for sure about them.

[Slartybartfast]

Wonder why they prescribed an AutoPAP and then locked it at 9 cm. It's hard to tell whether you need more or less pressure that way, but I agree you ought to hang loose until the dust settles. Get used to sleeping with the mask on, etc. Then once you have accumulated enough data to establish a pattern, talk to the doc again and give him/her a chance to guide you. Since you have a mixture of events, there might be something else going on.

[pats]

Wonder why they prescribed an AutoPAP and then locked it at 9 cm. It's hard to tell whether you need more or less pressure that way, but I agree you ought to hang loose until the dust settles. Get used to sleeping with the mask on, etc. Then once you have accumulated enough data to establish a pattern, talk to the doc again and give him/her a chance to guide you. Since you have a mixture of events, there might be something else going on.

I also saw a lot of CA events during my first night on APAP. They reduced to insignificance as I got used to the mask and machine, and spent less time either awake or semi-awake, so I agree with the advice to hang loose until the dust settles.

[Heavylids]

yarrow...I had almost the exact AHI from my sleep study in Feb 2012...AHI 20.5. After the initial pains from being a new user I am now seeing AHI levels on my S9 Autoset of under 1 most of the time. One suggestion. If that's you in your avatar picture then you may have to trim off the chin hair a bit. I have a goatee and have to keep it really short now. I noticed your leak rate is pretty darn high and probably causing a loss of pressure when you need it. Also my machine is set to APAP with a minimum of 4 and max of 12. The 95% pressure rate is, I believe, around 11.5 .Seems to work well for me. Good luck!!

[yarrow]

@ Pugsy: Thanks for the sleep study advice. I've left a message with my lab saying I'd like to get them. I suspect I'm hyperventilating -- enlarging the graph shows a pattern that looks very much like the Cheyne-Stokes examples from Wikipedia http://en.wikipedia.org/wiki/Cheyne-Stokes_respiration or ResMed http://www.resmed.com/us/clinicians/abo ... ation.html. My nose is usually rather stuffy from allergies, and it's easier to breathe out against the pressure if I breathe in deeply with it. I'm going to use Afrin tonight as an experiment -- if the C-S goes away with Afrin and comes back without it, I'll be on my allergist's doorstep next week.

@ Slartybartfast: My DME told me I'd be getting an S9 Elite, but then gave me an Autoset. There's only about $50 difference in price -- I suspect they just didn't have the Elite in stock.

@ pats: Yes, I'll follow everyone's advice and wait for the dust to settle.

@ Heavylids: Thanks for the encouragement. I'm using a nasal mask, so chin hair is irrelevant for now, but if it turns out I'm mouth breathing and need a full-face I'll need to deal with it.

Thanks, all!

[Bons]

"@ Slartybartfast: My DME told me I'd be getting an S9 Elite, but then gave me an Autoset. There's only about $50 difference in price -- I suspect they just didn't have the Elite in stock."

You won big time!! You ended up with a much better machine.

As to slartybartfast's question: My husband's doctor ONLY prescribes autosets. His theory is that since the insurance companies permit machines every five years, he wants to keep patients' options open. Better to have an autopap available and set as a cpap than have a cpap and later wish you had an auto.

[Pugsy]

Yep, sure looks like CSR. Just watch things. Sounds like you have done your homework and understand what to watch for.
I am sure I also don't need to caution you about the Afrin but I will just in case a newbie reads this.
Afrin rebound is an ugly beast to get rid of...I know because I have had it more times than I want to count.
So use sparingly as the directions suggest and if a past known Afrin addict (like me) even more sparingly.

[yarrow]

I am sure I also don't need to caution you about the Afrin but I will just in case a newbie reads this.
Afrin rebound is an ugly beast to get rid of...I know because I have had it more times than I want to count.
So use sparingly as the directions suggest and if a past known Afrin addict (like me) even more sparingly.

Thanks for the warning! I did know - a friend kicked the Afrin habit a year or two back - but I could have easily missed that.

[yarrow]

Second night -- Afrin experiment

Afrin eliminated all but one obstructive event. I seemed to be sleeping better, but woke up about once an hour with a very dry mouth. Kept getting up, drinking water, turning the humidifier up, going back to sleep. Finally decided the humidifier had run out of water, took it out to refill, and realized that it had plenty of water. By that time I was thoroughly awake, so I searched here for "dry mouth" and of course realized that I'd taught myself to breathe through the mouth! In two nights. Checked out the SD card with SleepyHead, and saw leaks into the mid 40s.

I'm afraid of chin straps because my teeth don't line up at all -- dentists keep telling me "No really, bite down naturally" and I tell them I can't do that because I've taught myself to hold my teeth apart always. Doing that against the pressure of a chin strap doesn't sound fun. But I was up for anything, and figured somebody here must know what do to if you need a chin strap in the middle of the night, so I searched for "improvised chin strap" -- and eventually found a post of SleepingUgly's describing her non-chinstrap solution with a self-adhesive Ace bandage. Off to the all-night Walgreens! Forgot to put the SD card back in the S9, so I lost a couple of hours of data, but went back to sleep 9:30 - 11:45 with the card inserted -- a few leaks up to 17, but most of the time single digits.

I'm very grateful to you folks!

Still lots of central events. I see that they're common at sleep/wake boundaries, and that's where they seemed to come in that late-morning sleep -- both from the graph and from the fact that I kept starting a dream and then waking up -- I think needed to breathe, though breathing might just be on my mind for some odd reason . Apparently 6 or 7 percent of folks diagnosed with obstructive apnea who start using xPAP machines develop central apnea -- usually for a month or two, after which it goes away. (See http://emedicine.medscape.com/article/3 ... ical#a0218)

[IndyDave]

I have a pretty good underbite, but the chin strap worked for me - the deluxe one someone on here recommended to me. Don't worry about them - they don't clamp your mouth shut, its basically just an elastic band that you connect the ends together with velcro. Even with it on really tight (just to see), I could still open my mouth to drink water. It really just provides some resistance to you trying to open your mouth, and keeps it from falling open. I was a serious mouth breather, day and night. I used it for about 5 nights, and after that went without - and found that short time was enough to train me to usually keep my mouth closed. My "puff index" which is breathing out through the mouth, is about 4-5 events per hour now - practically nothing... and I know some of those are artifacts or me knowingly doing so - yawning as I fall asleep and so on. The ace bandage gives you an idea of how it will work, but it isn't as effective (I tried that too).

[RandyJ]

I have struggled with a stuffy nose/allergies, and have even had to use my full face mask on occasion. What seems to have finally helped is Nasonex nasal spray at bedtime. I had used it in the past, but had not used it for a while. My allergist convinced me to try it again, and it worked. I had been waking up during the night with my nasal passages 90% blocked; it felt like breathing through a straw, and exhaling against pressure was tough.

Much better now.

[yarrow]

... the chin strap worked for me ... Don't worry about them - they don't clamp your mouth shut, its basically just an elastic band that you connect the ends together with velcro. ... The ace bandage gives you an idea of how it will work, but it isn't as effective (I tried that too).

I'll think about it! The Ace bandage trick from SleepingUgly was to wrap it around the head horizontally, so it covers the mouth, rather than to go over the crown and under the chin. As I said, I hold my mouth open(ish), with lips closed, because my bite is terrible. Extra pressure on the jaw doesn't sound fun. The Ace seems to be working fairly well -- I sometimes wake up with it having slipped down from my mouth.

I have struggled with a stuffy nose/allergies, and have even had to use my full face mask on occasion. What seems to have finally helped is Nasonex nasal spray at bedtime. I had used it in the past, but had not used it for a while. My allergist convinced me to try it again, and it worked. I had been waking up during the night with my nasal passages 90% blocked; it felt like breathing through a straw, and exhaling against pressure was tough.

I'll talk to my allergist about that. Thanks!

[RandyJ]

If you do decide to try Nasonex (or Flonase, etc), be aware that it can take up to a week or so of using it daily before you notice any relief. It's not instant like Afrin but it's safe for daily, continuous use.