Misdiagnosed?? and need help.

[dooger54]

Ok, so tonight I am shaving my goatee and will attempt to get a good seal using my F10 FFM. I will keep my setting for now at a constant 8. I am currently not using the EPR feature.

I emailed my doc today and am waiting for a response. I did talk to him last week about my issues and he wanted to give it more time to get a better idea of what is going on. And that makes sense. It's only been 12 days.

I will post Sleepyhead report tomorrow. Thanks!

[kteague]

I am not being treated for restless leg but that issue is still up in the air. The sleep study doctor noted to my personal physician the following - "Would treat periodic limb movements if clinically indicated"

Does your wife say your legs are still moving a lot at night when using the CPAP? It wouldn't surprise me if treatment does become "clincially indicated". With limb movements sometimes there's a lot of wake time we don't remember, and that could be skewing clear airway readings. It may take you a while to sort through everything, but unless the gurus here (which I'm not) clearly see a need to address centrals or complex events with another machine, just thinking those might settle down if your legs would let you sleep soundly. So much remains to be seen.

Docs usually first choose a dopamine agonist to treat limb movements. Not gonna preach against it as those meds have been a lifesaver for some, but will say please become fully informed before embarking on this mode of treatment. They are sometimes prescribed at too high a dose and end up causing more trouble than they fix. (Look up dopamine agonist augmentation.) It is thought that those most prone to developing augmentation are those with low ferritin (storage iron). If you think you may want to try these meds at a low dose, it would be prudent to get your ferritin level drawn and make sure your level is near 100 before starting the med. Don't accept a lab result answer of "normal" because the acceptable level for the general population is not considered adequate for those with limb movements of sleep. It also wouldn't hurt to have your magnesium and Vitamin D levels checked too. I may be missing a few. Give your body all the nutritional and lifestyle support it needs (no late caffeine etc) and if that doesn't bring resolution, you may need pharmaceutical intervention. Just curious if you have any problems with achy feet and legs?

In the meantime, some of the good folks here will be glad to help you work through any OSA treatment issues. Best wishes going forward.

[dooger54]

See below for last nights results. I used my Airfit F10 FFM. Leak rates much better than usual, but still had instances during the night of leaks. Not sure how to resolve those.

Also note that I was awake pretty much the entire time between 4:30-5:30. Gave up and took of the mask, went back to sleep for two hours!

[dooger54]

I am not being treated for restless leg but that issue is still up in the air. The sleep study doctor noted to my personal physician the following - "Would treat periodic limb movements if clinically indicated"

Does your wife say your legs are still moving a lot at night when using the CPAP? It wouldn't surprise me if treatment does become "clincially indicated". With limb movements sometimes there's a lot of wake time we don't remember, and that could be skewing clear airway readings. It may take you a while to sort through everything, but unless the gurus here (which I'm not) clearly see a need to address centrals or complex events with another machine, just thinking those might settle down if your legs would let you sleep soundly. So much remains to be seen.

Docs usually first choose a dopamine agonist to treat limb movements. Not gonna preach against it as those meds have been a lifesaver for some, but will say please become fully informed before embarking on this mode of treatment. They are sometimes prescribed at too high a dose and end up causing more trouble than they fix. (Look up dopamine agonist augmentation.) It is thought that those most prone to developing augmentation are those with low ferritin (storage iron). If you think you may want to try these meds at a low dose, it would be prudent to get your ferritin level drawn and make sure your level is near 100 before starting the med. Don't accept a lab result answer of "normal" because the acceptable level for the general population is not considered adequate for those with limb movements of sleep. It also wouldn't hurt to have your magnesium and Vitamin D levels checked too. I may be missing a few. Give your body all the nutritional and lifestyle support it needs (no late caffeine etc) and if that doesn't bring resolution, you may need pharmaceutical intervention. Just curious if you have any problems with achy feet and legs?

In the meantime, some of the good folks here will be glad to help you work through any OSA treatment issues. Best wishes going forward.

My doc is supposed to call me today. I will discuss this issue with him. Thanks.

[OkyDoky]

Your leaks do look much better. Have you tried a liner? They help some people with leaks especially if your face gets oily and causes the mask to move.
http://padacheek.com/ owner Karen is a member here and has some great products.
I'll leave the graph interpretation to others.

[dooger54]

Your leaks do look much better. Have you tried a liner? They help some people with leaks especially if your face gets oily and causes the mask to move.
http://padacheek.com/ owner Karen is a member here and has some great products.
I'll leave the graph interpretation to others.

Hopefully its just some more tweeking of the straps on the F10. If that doesn't help I will look into a liner. Thanks.

[dooger54]

Below is the Sleepyhead data from last night. Leaks are getting less but I still have work to do. May have to try a different mask.

Notice I had 42 Centrals, 24 Hypopneas and 4 Obstructives. It would be helpful if someone could make a recommendation of what I might change in my settings to help?

Increase/decrease pressure? Change to APAP mode? Use the EPR setting?

thanks!

[Pugsy]

Until we know what the disposition of the centrals really (awake/semi awake breathing or asleep real centrals) changing to apap mode is not usually advised because if the centrals are caused by the pressure then having the machine go chasing those hyponeas and/or OAs, snores, FLs could potentially make the centrals worse if pressure itself is causing the centrals.

EPR...sometimes using EPR will reduce centrals that are caused by cpap pressure because with EPR the machine functions like a bilevel pressure machine to some extent with the max 3 cm reduction on the ResMed machines. Bilevel machines are usually the first thing tried for problematic centrals.

There is a very small % of people who use cpap and bilevel will have centrals occur due to the bilevel nature of the pressure...so for those people it is suggested to turn EPR off. This is rare though...I haven't seen this happen very often at all.

If those centrals are awake/semi awake breathing irregularities getting flagged by mistake we don't do anything about them because we can't nor do we need to. More pressure with your machine won't fix the centrals anyway...more pressure is only used for obstructive in nature apnea events.
Problem is knowing for sure if those centrals are "real" or awake breathing getting flagged.

If it were me I would start with easiest and simplest thing to try first and that is increase EPR....that is of course assuming I felt I was sleeping soundly for the bulk of the night and didn't have a lot of awakenings during the night.
One change only at a time and give each change a few nights to see how things go. If you start changing more than one thing at a time then if you see results...good or bad...you don't have any way to know which change might be responsible.

[dooger54]

If it were me I would start with easiest and simplest thing to try first and that is increase EPR....that is of course assuming I felt I was sleeping soundly for the bulk of the night and didn't have a lot of awakenings during the night.
One change only at a time and give each change a few nights to see how things go. If you start changing more than one thing at a time then if you see results...good or bad...you don't have any way to know which change might be responsible.

Ok. So I will try the EPR beginning tonight. Should I set it a 3?

[Pugsy]

I would start with EPR set to 3 if it were me..
It's closer to the usual pressure support setting when bilevel machines are used for whatever reason.
The usual is 4 cm to 5 cm pressure support (difference between inhale and exhale) and with using EPR set to 3 on a ResMed machine the difference is 3 cm.

Now sometimes that reduction in exhale will cause the OA index to increase if that 3 cm drops allows the airway to try to collapse...but it doesn't always...so that's why I say try it and see what happens.
We might see a drop in CAs/centrals (if they are related to pressure) but we may or may not see an increase in OAs with that drop in exhale of 3 cm. Won't know till you try.
Now if you happen to be a member of that very small group who see an increase in centrals with bilevel...we turn EPR off and see what happens.
Unless the results are absolutely horrible don't go changing things based on 1 night's results. Nights will vary with no changes at all and we need multiple nights to make sure the results are consistent.

[dooger54]

I'll try it for 3-4 nights and see what happens. Thanks!