CPAP attempt #2

[txdad]

After waking up choking while trying to sleep on my back, I finally got a Sleep study done. That was about 5 years ago. Initial results were AHI at 7 when I fell asleep, 42 when I hit REM. What was supposed to be a split study was never comleted because of the low incidents pre REM. I was given a Resmed S9, set at 14, given a full mask and sent home. After trying unsuccessfully for months, I finally gave up and the machine ended up in my closet. Flash forward 5 years and my doctor said he would not prescribe anything more for symptoms such depression, ADD, and low testosterone until I got my sleep figured out. This time, the results were slightly different and we did a mandatory split study. This time I showed levels of 16 events/hr our of REM, with no REM readings because, after 195 minutes, I had 0% REM. After putting me on the machine, they ramped from 5 to 6, with 6 seeming to the optimal setting. This time, they have sent me home with a RemStar 460 from Respironics, humidifier, and Nuance Pro Nasal Pillows. I have only been using it for a few days, but the success of keeping it is already a bit better. I can fall asleep with it on much easier, and, though I am still taking it off at night, it went from 4 hours on to 6, and think it should continue to get better.

Here is my issue early on, with the caveat that I have my first follow up next week. Last go 'round, I remember having 1 solid night and feeling great the next day, really refreshed. This time, it's the opposite. I feel groggy when I get out of bed and hit a brick wall mid day where I cant function and just want to have a nap. Is that typical when first using the machine?

[JDS74]

The Respironics 460 is a single pressure cpap machine and is also a full data machine.
So: update your equipment to reflect this machine. You have likely selected the incorrect model.
The correct one is PR 460 Pro C-Flex+

You definitely have selected the incorrect humidifier model.
The correct one is the Series 60 with heated humidifier and heated tube.

Then get a copy of either Encore or SleepyHead so you can look at your therapy data before you have your follow-up.
Post a request for "Respironics CPAP Software" and someone will send you links on how to download.

The Encore software is Respironics version and requires a Windows computer.
SleepyHead is written by a forum member and will run on Windows or Mac OS.

Are you still taking off the mask at night? When that happens do you wake up? If so, put it back on and go back to sleep.
If you still feel poorly in the morning, it may be that the current pressure is too low. The software will be able to tell you in detail if that is the case.

In the meantime, take a look at the numbers on the machine display and see what they say about the number of apnea events from the prior night. It's better than nothing and will give you a general idea of what is going on.
With the machine plugged in, turn the dial knob until "INFO" is highlighted. The press the knob and you can scroll through the various numbers.

[txdad]

I have already installed Sleepyhead and have been looking at the numbers. What's the best way to post here? The software lists my machine as "RemStar Pro with C-Flex+ (460P)" - which is why I chose the one I did....and the humidifier was guess. SleepyHead was not a choice in the software list...should that be changed?

[JDS74]

The one you chose is the 50 series machine. Look a little higher in the list for the series 60 machine. Then it will display.
The humidifier is also a 60 series with heated tube if the one you have is clipped into the side of the machine.
is this the one?
PR System One 60 Series Heated Tube Humidifier with Heated Tube

Is this your machine?

PR System One REMStar 60 Series Pro CPAP Machine

For posting, you can just list the various values on the left side of the screen.
Of particular interest are the apnea numbers:
Clear Airway
Obstructive
Hypopnea
Etc.

Then you might take a screen shot and post it to a site like PhotoBucket or Imgur.

[Sleeprider]

I have already installed Sleepyhead and have been looking at the numbers. What's the best way to post here? The software lists my machine as "RemStar Pro with C-Flex+ (460P)" - which is why I chose the one I did....and the humidifier was guess. SleepyHead was not a choice in the software list...should that be changed?

Use this tutorial to post data. https://sleep.tnet.com/reference/tips/imgur

Good luck!

[txdad]

Here is 2 nights ago


Last night was a good 6 hours, but had 4 drinks that evening, so readings may be a bit off

[txdad]

Today was the same thing....and I don't wake up to an alarm. Really groggy when I first woke up...then by, 3-4 PM, hit a brick wall and couldn't function, felt like I needed a nap - big time! I don't do caffeine after 11 am, otherwise I can't go to bed by 10 or so. The grogginess in the morning only started once I started using the CPAP.

[kteague]

Agree that the first step is making sure your treatment is optimized. Just want to say once my body/brain knew it could get some good sleep, I craved it like crazy. All I wanted to do was sleep for a while. I've heard some on here explain it as the response to no longer being stimulated by the stress hormones that accompany sleep apnea. That made sense to me, and I think once I no longer needed to stay on alert due to impending danger, I relaxed to the max. And it may just be a period of recovery - we always need more rest when we are recovering. If your treatment is working, and all the above is in play, you should see the need for sleep decrease. If it doesn't, you may want to start looking for other contributors, but for now I'd just make sure to get adequate sleep - not just the amount required for maintenance, but some extra to aid in recovery. It's the kind thing to do for yourself.

[Pugsy]

You still have incorrect equipment showing in your profile. When you have time could you correct it to avoid possible confusion later.

Your machine should be....PR System One 60 Series Pro CPAP with C Flex
The humidifier would be....PR System One 60 Series Heated tube humidifier with heated tube (even if you aren't using the optional heated hose at this time).

Right now the one thing that stands out on the reports is hours of sleep.
6 hours isn't enough to expect to feel much improvement much less with less than 6 hours.
Are you sleeping solid with maybe one or two wake ups or are you waking often for various reasons?

This past week I had 3 nights where I got 5, 5 1/2 and 6 hours (dogs were the problem) and my butt was dragging real bad by mid afternoon. If I get less than 7 hours of sleep I definitely feel it during the day with fatigue and a strong need to nap.

[txdad]

I was missing the CFlex+ part...got changed...but when I put PR System One REMstar Pro CPAP Machine with C-Flex Plus, my Machine Text nor image shows...also I do not have the connector for the heated tube, it is just a smoky plastic tube coming out of the top.

[Pugsy]

when I put PR System One REMstar Pro CPAP Machine with C-Flex Plus, my Machine Text nor image shows...also I do not have the connector for the heated tube, it is just a smoky plastic tube coming out of the top.

That's because the PR System One Remstar Pro CPAP machine with CFlex Plus is the model 450 and that link is broken because that is a discontinued machine.

Your need to look for the same model in the equipment list but with the "60 Series" in the model name.
The REMstar part is useless and means nothing...Respironics has used that term on all their machines pretty much since they started making them.

And even though you aren't using the heated hose with your model 460 machine...the correct choice for humidifier is still PR System One 60 Series heated tube humidifier with heated tube. The PR System One Heated humidifier choice pertains to the 50 series humidifier and that humidifier won't work with a 60 series machine which is what you have...that's what those last 2 digits denote...series...450 is 50 series and 460 is 60 series.

Look at my equipment choices...both humidifier and machine are 60 series and sometimes I use a heated hose and sometimes I don't but I still choose the choice I have made for humidifier because that's the only choice that works with the 60 series machine.

The CFlex part isn't critical to the model name either...all the PR S1 Pro machines have had CFlex +.

[Sleeprider]

I'm surprised no one has said it yet...your pressure is too low. With all those snores and OA, you should probably be at a 6.0 minimum pressure. I see you at 4 or 5 with the machine making periodic auto-titration changes, but the starting pressure is allowing you to snore, and that is obstructive, and probably contributing to RERA.

Nice start, and things should get better with more sleep and slightly higher pressure. Do you know how to change the minimum pressure?

[txdad]

OK...changes made. I was under the impression my minimum was 6, with a ramp starting at 4. How can I verify?

[Pugsy]

The first report from 2 nights ago the minimum pressure of 6 is fine.
The night after the 4 drinks with all the snores and stuff...the minimum of 6 doesn't do a good job.
Unless you drink 4 drinks often I would base my therapy on the non alcohol nights.
That's why I didn't comment on the rather ugly looking report after 4 drinks.
Perhaps you ended up on your back more that night and often when supine sleeping we simply need more pressure.

You might want to get the provider/clinical manual for your machine as it explains the features on your machine as well as how to get to the clinical setup menu to verify settings.
You can request it here...be sure to request the correct model machine
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

SleepyHead is reporting 4 cm minimum setting in the statistics but it is also saying maximum of 0 which we know is incorrect. The graph looks like ramp of 15 minutes from 4 to 5 minimum. Changing the minimum to 6 might help with those snores and stuff if they are from supine sleeping more than alcohol causing the airway tissues to relax more.
Sometimes SleepyHead has trouble with the statistics settings section.

You are also using APAP mode...are you aware that the 460 model machine has limited APAP mode....30 days.
Explained in that manual above.
Now there is a way to reset the machine and I think it can be done 5 times so that you can get more APAP days but eventually you run out of apap mode days.

Was the plan to maybe run apap mode for a couple of weeks and come up with a fixed cpap mode pressure?

[txdad]

Had a good night last night as far as time with the pillows in...



Will see if I can bump the min up and let that ride till my appointment on Friday, at which point I will ask about their plan. I assume I would want to push for a full APAP machine and not this one...correct?

On a side note, was able to evangelize this site to a friend who had let his mask get old and never fix his SD card problems...resulting in poor sleep again. He is going to push for a new sleep study and an APAP machine as well.