Stuck in the Middle East, no proper doctor available

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
learflyer
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Stuck in the Middle East, no proper doctor available

Post by learflyer » Tue Oct 16, 2018 12:33 am

Hi good day,

my sleep apnea was diagnosed recently, and despite my Dream Maschine not properly setup yet, I already feel better.
Now to my problem, where I hope you can help me.

I am currently living in the Middle East, and while we have loads of sun and sand, we lack doctors with a standard that I am used to from where I come from (Europe). Which leaves me with a nice new Dream Station Auto Cpap machine, but no one to tell me which settings to use. So based on research and suggestions from others I have set my device to the following:

Ramp: 4.0
Ramp Time: 20 minutes
Pressure Auto (min. 6 - max 12)
A-Flex, Flex Setting 3
Auto Humidifier

I initially started with a AHI of 10 which went down to 4,22. However after that it increased back to 10 and last night it was at 8,63. I can see that the majority are Hypopnea events and at least yesterday the pressure was mostly at 6,0 so maybe 6 is too high?

I feel great already compared to "pre treatment" So my afternoon tiredness is gone and I wake up refreshed. But of course I would love to get below 5.0. Can you have a look at my latest sleepy head charts below and suggest a better setting? Mind, I am just recovering from a cold I had through the full treatment phase, so nose is still a bit clogged. (I can breath trough the nose)

Thanks a million
Alex
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Pugsy
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Re: Stuck in the Middle East, no proper doctor available

Post by Pugsy » Tue Oct 16, 2018 6:03 am

Welcome to the forum Alex.

Can you do me a favor please and in the future post images but with not so many graphs on the right side? So many graphs means they have to be so small and harder to evaluate. We only need 4 from a Respironics machine....Events, Flow Rate, Pressure and Leak.
In the format shown here.
viewtopic/t158560/How-to-post-images-for-review.html

Your pressure settings work well part of the night and not so great other parts of the night. This happens often (I had it happen to me at first myself) and when this happens it's usually either we are on our backs (supine sleeping) or in REM stage sleep...or sometimes a combination of both.
Question for you....were you on your back when you went to sleep and when you finally got up...when the bulk of your clustering of events was going on?

Another question for you....how much time awake at the beginning of the night was spent with mask and machine on?

It's very common to need more pressure when on our backs or in REM stage sleep. The timing of the clusters don't really go along with REM stage sleep all that much (especially the beginning of the night and the end of the night clusters) so supine sleeping would be my first suspect.

Now you could try to stay off your back to see how much difference that would make but that's often easier said than done and your pressure settings are low in the grand scheme of things so if it were me I would just give the machine a better head start with more minimum pressure so it can get to where it needs to be to better hold the airway open in the first place. These machines work better by preventing the events instead of trying to fix them after the fact and despite the auto function for auto adjusting pressures they sometimes can't respond quickly enough. They don't go from 4 to 10 cm in the blink of an eye. It takes a period of several minutes for the machine to evaluate and respond and while the machine is doing its thing the airway closes and opens back up again.

Best thing to do is increase the minimum so the machine has a better head start to get where it needs to be. Quite common really...I had to do it myself because for me it was REM stage sleep issues. I sometimes would need a lot more pressure during REM than other parts of the night.

So I would increase that minimum pressure to maybe 7 cm IF...you were asleep that first hour and ending hour.
If you were awake that first hour and ending hour then those flagged events aren't real and instead the machine flagging awake breathing irregularities by mistake. It has no way to know if you are asleep or not and our awake breathing is irregular and it will often get flagged. If we are awake when those flags happen it doesn't count because they only matter when we are asleep.
Awake stuff doesn't count and has to be omitted from the evaluation process.

So more minimum pressure if you were asleep.
If you weren't asleep then we need to try to figure out why you are having trouble sleeping.

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learflyer
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Re: Stuck in the Middle East, no proper doctor available

Post by learflyer » Tue Oct 16, 2018 6:46 am

Thank you for the kind words.And sorry for the graph, will comply next time.

As for the back sleeping, yes this is definitely happening. While I did not sleep right away after putting on the mask, I am pretty confident it did not take more than 10 minutes to fall asleep. Also for the waking up part. 10-15 minutes max.
I am going to adjust minimum to 7 and take it from there!

Thanks a lot really, getting a reply so quickly means so much!

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Pugsy
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Re: Stuck in the Middle East, no proper doctor available

Post by Pugsy » Tue Oct 16, 2018 7:01 am

No need to apologize about the graph. I could see what I needed to see well enough.
Most people tend to want to show us a lot more than we really need. :lol:

I think you will see more consistent results with a higher minimum. You might need a little more but a jump from 4 to 7 is plenty for a single jump....and it might get the job done.

Supine sleeping wasn't ever a big thing in my pressure requirements (but it can be for others) but instead with REM I would sometimes need 6 to 8 cm more to hold the airway open. It's quite common and no big deal.
If your pressure needs were in the mid to high teens we might suggest trying to limit sleeping position to side sleeping to avoid the higher pressure needs but in your situation with your pressure needs fairly low I suggest just a little more pressure minimum and sleep in any position you wish. It's not always so easy to stay in one position and some of us can't do that for various reasons anyway.

Let me know how it goes. If you have trouble adjusting to 7 cm...go up in 1 cm increments but 7 cm is normally not too much for anyone to handle.

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jnk...
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Re: Stuck in the Middle East, no proper doctor available

Post by jnk... » Tue Oct 16, 2018 7:21 am

learflyer wrote:
Tue Oct 16, 2018 12:33 am
Ramp: 4.0
Ramp Time: 20 minutes

. . . just recovering from a cold I had through the full treatment phase, so nose is still a bit clogged. (I can breath trough the nose)
Ramp is a comfort feature. If it makes you more comfortable falling asleep at that pressure, great. But for me, especially during a cold or a clogged nose, I would find that ramp setting less than comfortable.
-Jeff (AS10/P30i)

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palerider
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Re: Stuck in the Middle East, no proper doctor available

Post by palerider » Tue Oct 16, 2018 6:36 pm

Pugsy wrote:
Tue Oct 16, 2018 6:03 am
Welcome to the forum Alex.

Can you do me a favor please and in the future post images but with not so many graphs on the right side? So many graphs means they have to be so small and harder to evaluate.
I think Alex just has a really big high res monitor... when I double clicked on the image, the stuff was huge... I think I need a 4k monitor to see it all at once though... :lol:

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Re: Stuck in the Middle East, no proper doctor available

Post by palerider » Tue Oct 16, 2018 6:38 pm

learflyer wrote:
Tue Oct 16, 2018 12:33 am
Hi good day,

my sleep apnea was diagnosed recently, and despite my Dream Maschine not properly setup yet, I already feel better.
Now to my problem, where I hope you can help me.

I am currently living in the Middle East, and while we have loads of sun and sand, we lack doctors with a standard that I am used to from where I come from (Europe). Which leaves me with a nice new Dream Station Auto Cpap machine, but no one to tell me which settings to use. So based on research and suggestions from others I have set my device to the following:

Ramp: 4.0
Ramp Time: 20 minutes
Pressure Auto (min. 6 - max 12)
A-Flex, Flex Setting 3
Auto Humidifier
I'd suggest trying min 8, max 20 pressure at this point. (the 20 is really mostly immaterial).

Those spikes on the pressure are what you want to see all the time with your kind of machine... and a little more pressure will hopefully do that.

btw, there's nothing good about an ahi of 5, that's like being poked by a sharp stick every 12 minutes, it's pretty crappy. Hopefully, you can get the obstructive part under 2.

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learflyer
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Re: Stuck in the Middle East, no proper doctor available

Post by learflyer » Tue Oct 16, 2018 10:57 pm

Pugsy wrote:
Tue Oct 16, 2018 6:03 am
I think Alex just has a really big high res monitor...
Guilty as charged :lol: I have a 4k monitor, even scaled. Well, if my sleep sucks at least my eyes work, right?

Now, I changed min pressure to 7, seems the AHI went down a bit, but with very big spikes. I felt ok'ish when I woke up, however sleepyhead shows I had a terrible night apparently from 2am onwards and than again from 4.30am.

I woke up around 4.45am, and not sure how long it took me to sleep again until I finally took the mask off short before 7am.

Guess its time to ramp up that min pressure even more? What I dont quite get from Sleepyhead is it claims that Median Pressure was 7.7 however 95% was 10.0 Is that not a contradiction?
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Re: Stuck in the Middle East, no proper doctor available

Post by Pugsy » Tue Oct 16, 2018 11:10 pm

Median pressure is a median average. Half the time above and half the time below.

95% pressure just means at OR BELOW that number for 95% of the night. It is NOT where a person spent for 95% of the night.

We don't need the AHI graph...we can easily see the clusters of events on the Events graph.

From the pattern of the clustering I would tend to suspect REM stage sleep needing more minimum pressure still...or maybe it was REM with supine thrown in for extra measure.

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Re: Stuck in the Middle East, no proper doctor available

Post by palerider » Tue Oct 16, 2018 11:31 pm

learflyer wrote:
Tue Oct 16, 2018 10:57 pm
What I dont quite get from Sleepyhead is it claims that Median Pressure was 7.7 however 95% was 10.0 Is that not a contradiction?
No: http://adventures-in-hosehead-land.blog ... de-to.html

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Re: Stuck in the Middle East, no proper doctor available

Post by learflyer » Wed Oct 17, 2018 6:37 am

Right - understood.
So I will proceed with 8.o for tonight and see further.

What worries me a bit is the high occurrence of CA. There is nothing much that can be done by CPAP against that right? As its a neurological issue.

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Re: Stuck in the Middle East, no proper doctor available

Post by jnk... » Wed Oct 17, 2018 6:47 am

learflyer wrote:
Wed Oct 17, 2018 6:37 am
What worries me a bit is the high occurrence of CA. There is nothing much that can be done by CPAP against that right? As its a neurological issue.
"Central Apnea" as a diagnosis sometimes involves a neurological issue. However, getting some flagged events in a home treatment machine labeled as pauses in breathing with an open airway is not the same thing as that.

Once CPAP has prevented obstruction for someone whose primary issue was obstruction, then better sleep without the occurrence of obstructions can, over time, allow many of those pauses in breathing to vanish.

Fix obstruction first, then let sleep improve, and then see what "events" are left over, if any.
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Re: Stuck in the Middle East, no proper doctor available

Post by D.H. » Wed Oct 17, 2018 7:16 am

A Sleepyhead "Clear Airway Event" is where a breathing cessation was detected, but no obstruction was detected. Current CPAP machine are very good. However, since they are not as invasive as being wired up at a sleep lab, they can't detect everything that would be find at a lab.

Also, you did not say where in the Middle East you are. I'm sure that there are some find sleep doctors in the Middle East.

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Pugsy
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Re: Stuck in the Middle East, no proper doctor available

Post by Pugsy » Wed Oct 17, 2018 7:20 am

You might want to go here.
http://freecpapadvice.com/sleepyhead-free-software
Read and watch all the videos

It's normal to have an occasional real central....like a sleep stage transition central or sleep onset central.
Centrals are only a problem when present in large numbers. Your numbers even if every single one of your centrals were real (which I doubt) aren't anywhere near enough to warrant concern.

It's very possible that the bulk of the centrals you see in close proximity to some flagged events are sleep onset centrals....the obstructive event disturbs your sleep...you go back to sleep and have a sleep onset central....or it is very possible that the obstructive event disturbs your sleep and you have a post arousal central flagged. If that's the case the central isn't real anyway and instead just a symptom of an arousal or an awakening. You have to be asleep before any flagged event of any sort is something to worry about.
Awake/semi awake stuff doesn't count except to be more of a sign of crappy sleep than anything else.

So like jnk says....fix what you can fix with your machine that needs fixing and then let's worry about the stuff you can't fix......if there is enough of them to worry about.

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Re: Stuck in the Middle East, no proper doctor available

Post by palerider » Wed Oct 17, 2018 11:38 am

learflyer wrote:
Wed Oct 17, 2018 6:37 am
What worries me a bit is the high occurrence of CA.
Where?

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