Nube looking for advice on settings and altitude

[MJColorado]

Thanks all for the info posted. It's nice to see at the beginning that there are others who have been through this. It's very easy to come home with a machine and feel pretty alone in this.

My situation is I effectively self diagnosed based on years of bad sleep. I did see a pulmonologist a few days ago who looked at me and said, "I know you have OSA just by looking at you." He prescribed a sleep study for me, however the sleep study for me is pending and has to be a home test due to me living at 9000'. I bought the equipment out of pocket rather than deal with the delays and nonsense of insurance. (Thanks Amazon)

Thankfully my mask fits well, but I'm flying pretty blind with the pressure. I set 10-20 and have had two horrible nights of 4ish hours. My AHI was 14.9 and then 21.4 on this setting. The 90% was 11.5 then 14.5. My wife said no snoring, but I do not feel like I slept at all.

Any advice on making this easier or specifics related to high altitude or other setting with my machine are greatly appreciated.
MJ

[D.H.]

Thanks all for the info posted. It's nice to see at the beginning that there are others who have been through this. It's very easy to come home with a machine and feel pretty alone in this.

My situation is I effectively self diagnosed based on years of bad sleep. I did see a pulmonologist a few days ago who looked at me and said, "I know you have OSA just by looking at you." He prescribed a sleep study for me, however the sleep study for me is pending and has to be a home test due to me living at 9000'. I bought the equipment out of pocket rather than deal with the delays and nonsense of insurance. (Thanks Amazon)

Thankfully my mask fits well, but I'm flying pretty blind with the pressure. I set 10-20 and have had two horrible nights of 4ish hours. My AHI was 14.9 and then 21.4 on this setting. The 90% was 11.5 then 14.5. My wife said no snoring, but I do not feel like I slept at all.

Any advice on making this easier or specifics related to high altitude or other setting with my machine are greatly appreciated.
MJ

The first suggestion is to raise the minimum to 11 (or higher if your 90% remains at 14.5). Note that this machine has automatic altitude compensation, so this really ought not to be an issue. Theoretically, you are above the maximum altitude supported, but Respironics assured me it would work anyway in Quito (which is even higher than where you are).

Also, you can download SleepyHead (for free) and analyze your sleep.

[jtravel]

you should get Sleepyhead software installed on your computer so that you can start reviewing the detailed data.
I was originally prescribed a Apap with a 5-20 setting and had a high AHI.
using sleepyhead I found 12-18 was where i needed to be and now my AHI is under 1 each night.
Mask leaks and mouth breathing can also have a effect.
Get sleepyhead installed and then post your graphs and others can offer advise.
http://www.apneaboard.com/wiki/index.ph ... d#pid73182

[bonjour]

The best advice I can give you is to download sleepyhead software (free)
then post your nightly graphs for us to look at. See my Sig below for how to.

There are several on this forum who are highly skilled at interpenetrating the graphs and can get you thru this easily. We will suggest changes to your settings and state why.

[MJColorado]

Thanks, D.H., jtravel and bon jour,

I gave my primary laptop computer to my mother for Christmas, since I didn't use it and she needed one and now have an IPad and an HP laptop that doesn't want to play nice. I'll have to get Sleepyhead on my work computer and post the graphs from there. From what I read, there is no way to use it from tablet??

[of_the_west]

Contrary to what others are suggesting here about adjusting your baseline pressure to be higher, I think it would be helpful to understand what type of apneas you're experiencing. For example, are your apneas primarily obstructive, or central? If you're having central apneas, are they following obstructive apneas? Are you still experiencing obstructive apneas while on CPAP therapy?

Some of us have a hypersensitivity to low CO2 levels, and this can cause us to have central apneas at altitude, and/or in reaction to CPAP therapy. Some people do better on ASV (adaptive servo ventilation) therapy to control central apneas because for some people CPAP can make sleep apnea worse at altitude. In my case, lowering the pressure, using a constant pressure (vs. an auto-PAP range), and turning off exhalation relief while on CPAP therapy significantly reduced the incidence of my central apneas -- and I have zero obstructive apneas. Your situation will be specific to you.

In short, you probably need to know more, and I would highly recommend working with a doctor who has some experience with the effects of altitude on sleep apnea. You may or may not be exhibiting complications due to living at altitude, but getting confirmation will help you and your doctor narrow down on treatment options.

[MJColorado]

Thanks West,
My Dr and I are assuming this is OSA rather than CSA based on my physiology alone. (Short, stout (borderline obsese) with a thick neck and non-priminant chin.) I have had a septal reconstruction with cut of the uvula for the anatomy although 10 years ago when I had this surgery, I was told I did not have sleep apnea even though they strongly suggested the surgery anyway. I wasn't aware of the sensitivity to CO2, but it is of concern based that I can run 2 miles at altitude without issue and resting O2 sat at 94%, also at 9000' However I feel occasional shortness of breath with minor movement and show an O2 sat then of around 88%. I have had the SOB and immediately put the Pulse/Ox on and get that 88%. Long way to get to my question, sorry, but could the CO2 sensitivity be driving the AHI and if so what is used to prove/diagnose it?

[Julie]

Get Sleepyhead - so many of your questions will be answered and it will give us a lot more to go by so we can advise.

[OkyDoky]

I wouldn't make any changes until you know what makes up your apnea. You can't really assume it is obstructive. You have a full data machine, so get Sleepyhead.
This site will help you learn how to download it. https://sleep.tnet.com/resources/sleepyhead
When you have it downloaded if you have questions we can show you how to post screen shots.

[MJColorado]

I managed to get access to the charts on Sleepyhead.





Any thoughts?

[Wulfman...]

Yeah.
Look at your reports as to where your pressure line is in relationship to where you're NOT having events.
Set your pressure......minimum AND maximum.......to that pressure and see what happens. (probably 10 cm. for both)


Den

.

[OkyDoky]

MJColorado, Do you know why you are frequently waking up? There are several CA's but most are around your wake ups so many could be false or Sleep/wake/junk. Once you are getting better sleep you can evaluate the CA's.

Increased pressure is not used to treat CA's but is used to treat obstructions and if the pressure is optimized to help you sleep better the false CA's will decrease. The Minimum pressure is the important one to help the machine prevent apnea. If you look at both nights you have a cluster of OA and Hypopnea before your machine can increase pressure to prevent them.

I would set your minimum to 11 and your maximum to 15. I differ a little on this from Wulman, at this time, because you are having variable pressure needs. Now if you have difficultly with the pressure increasing with this narrower range it may be an idea to visit.

The Min of 11 may later need to be increased a little and the top may need to be increased a little also if you are bumping the top a lot. Once you make a change evaluate it for a few days before you make any other changes since every night is different and that way you know what changes made a difference.

Let us know how things go.

[MJColorado]

I have no idea why I'm waking up. Could be a number of things, but I'm thinking it's related to the discomfort of the mask. I tried a nasal only version from PR and really had an issue with just wearing it.

In fact my question at this point: does this data conclude I have OSA? I would guess yes based on advice of where to put the pressures. Is there anything else here that needs addressed? I won't be in contact with my Dr until Monday at the earliest.
Thanks

[Wulfman...]

Thanks all for the info posted. It's nice to see at the beginning that there are others who have been through this. It's very easy to come home with a machine and feel pretty alone in this.

My situation is I effectively self diagnosed based on years of bad sleep. I did see a pulmonologist a few days ago who looked at me and said, "I know you have OSA just by looking at you." He prescribed a sleep study for me, however the sleep study for me is pending and has to be a home test due to me living at 9000'. I bought the equipment out of pocket rather than deal with the delays and nonsense of insurance. (Thanks Amazon)

Thankfully my mask fits well, but I'm flying pretty blind with the pressure. I set 10-20 and have had two horrible nights of 4ish hours. My AHI was 14.9 and then 21.4 on this setting. The 90% was 11.5 then 14.5. My wife said no snoring, but I do not feel like I slept at all.

Any advice on making this easier or specifics related to high altitude or other setting with my machine are greatly appreciated.
MJ

Without an in-lab sleep study, you ARE "flying blind" in this.
I still suggest using a straight pressure. It could be the pressure changes are disturbing your sleep.
Nothing wrong with experimenting with a range of pressures, but in this case, you don't know if the CAs are being caused by the pressure increases. Theoretically, the pressure should drop if Centrals are detected.
ResMed had an algorithm in their old machines that would not typically pursue apneas above 10 cm. because their studies indicated that "Pressure-Induced-Centrals" tended to occur above the pressure of 10 cm.
For that reason, I'm recommending a straight pressure of 10 cm. for the time being until you can see what happens.
You need to start with a "base line" because the pressure changes can cause too many problems with interpreting the reports.


Den

.

[OkyDoky]

I have no idea why I'm waking up. Could be a number of things, but I'm thinking it's related to the discomfort of the mask. I tried a nasal only version from PR and really had an issue with just wearing it.

You have no large leaks with your mask so that is a good thing.

In fact my question at this point: does this data conclude I have OSA? I would guess yes based on advice of where to put the pressures. Is there anything else here that needs addressed? I won't be in contact with my Dr until Monday at the earliest.
Thanks

Yes it looks like you have OSA. If you look at the numbers on the left in the colored area it tells you how many events an hour you have in each category. Even treated with pressure you are having enough OA and hypopneas to make that call.

As far as the CA's we can't know for sure without a sleep study if they are real. During a sleep study they monitor your brain while measuring if you make any effort to breath. That way they can tell. Any drug that effects your brain can cause them. Some neurological conditions can cause them and we have seen where high altitudes can influence them. But they can also be false because many times when we are not sleeping well we are holding our breath and sighing while we toss and turn. The machine can't tell if you are asleep.
If they are real, pressure does not help them and may make them worse.
An important think to ask is if the Home Study you are having records Centrals.
It won't hurt to try Wulfman's suggestion first and monitor the results with Sleepyhead. I do think to control your apnea it will take a little more than 10cm.

Now we need a better organized screenshot for your next post so here is a link to help you with that. Some of the graphs and info on the left side are more important than the others. https://sleep.tnet.com/resources/sleepyhead/shorganize There will be 3 pages so when you get to the bottom click on the next one.