New to CPAP and the forum

[Sloth]

Hi All,

Trying to wrap my head around all this and the massive change that's just happened in my life.

After 4 to 5 years of snoring I finally saw the doc about it and ended up having an in-hospital sleep study.

The result: "Severe non-positional OSA for which CPAP should be considered". Moderate to heavy snoring throughout the sleep period and an AHI of 58.5/hr, high arousal index of 38.2/hr with increased event frequency when supine (AHI 61.7/hr). A bit worryingly I also desaturated to 84%.

The respiratory data was scored at 410 Apnea + Hypopnea, 133 OA and 9 CA. So you could say I didn't have a great night

I was given a prescription for APAP 4 - 20 cmH2O. My doc then wants me to move to CPAP at the 95th percentile. Because Christmas, looks like I'll rent through to end of Jan and stay on APAP until then (scheduled appt with sleep doc end of Jan).

A couple of weeks ago I started a CPAP trial and was given a Dreamstation APAP machine and nucance pro (medium nasal pillows). First night my AHI was under 5 so I'm pretty pleased with my bodies response to the therapy. I had a bit of nasal soreness and also arousals due to leaks so I tried a F&P simplex full face mask for 3 nights (disaster), the nuance pro with large size nasal pillows (Great) ... and tonight I'll try a f&p eson 2 mask ..... still just trying to find what works best for me.

I want to post up some data so I'll put my summary data, my best night, worst night and an average night. I would love some feedback on the results. I'm a DevOps/Software engineer by trade so I'm comfortable with the technical side of things but I'm still trying to learn how to interpret the charts from youtube vids and doco ... its always easier if someone with a bit of experience can add a few pointers

I'm stoked I've gone from 58 to less than 5 AHI on average but I am still really keen to optimise my results and also to be prepared with the right questions when I have my next appointment with the sleep doc. So my main two main questions at this point are:

1. Should I be concerned about the periodic breathing that is showing up in the charts?
2. Is there anything else looking at the charts that stands out to any of you as something that needs a closer look?

Summary:

summary.png (125.85 KiB) Viewed 816 times

Worst Night First:

Worst.png (211.31 KiB) Viewed 816 times

Closer look at PB ... lasted about 30mins...

PB.png (96.74 KiB) Viewed 816 times

[Pugsy]

Welcome to the forum.

Ignore the CSR/Periodic Breathing for now. I would need to see much more of the breathing prior to when it started to be sure but it might be related to awake/semi awake breathing.
It might be more related to the obstructive stuff causing arousals which in turn cause arousal/post arousal centrals/CAs and they aren't real.
Let's worry about it later if it pops up once you have the OSA better controlled.

You probably started out the night on your side but eventually rolled over onto your back around 4:30.
At that point the airway collapsed more and you needed more pressure to hold it open. The machine tried to get it done but going from 4 to 10 just took too long and the machine couldn't quite get the desired job done.

Change the minimum from 4 to 6 or 7.....give the machine a better head start for those times when you need more pressure.
Often when the baseline pressure is more optimal the machine won't need to go quite as high and the 90/95% number will reduce a bit.

I have been through a very similar situation only my issue was REM sleep stage. My OSA is worse in REM.
It's quite common...to need more pressure when on our backs or during REM.

Oh...you might want to learn about awake vs sleeping flagged events. How to tell the difference.
Go here and read and watch all the videos.
http://freecpapadvice.com/sleepyhead-free-software
Awake/post arousal/semi awake stuff...doesn't count and we ignore them for the time being.

[Sloth]

Thank you for your reply Pugsy. Makes complete sense and you're right in that I definitely started the night side sleeping.

The machine I've got has settings locked by the rental supplier ... It's also reporting back via it's modem so I'm a bit hesitant to change settings at the moment. Once I buy a machine at end of January I'm definitely going to tweak (and turn off the back-to-base reporting). I tried an eson 2 mask last night which was great .. had a few leaks with the large cushion so I dropped by the rental place and borrowed a medium to try. Hoping for a good night tonight!

If I may ask another (long-winded) question?

I know my doc is keep to move me onto a CPAP machine set at the 95th percentile of the auto pressure over the rental period. ..... I'm not sure how I feel about that ... The doc made a big thing about the machine being cheaper if it's CPAP and that apap can cause awakenings with pressure changes (I don't think it has for me personally). I have a nagging feeling I'm missing out on some customisation options if I change machine. I'm quite happy with the dreamstation apap in general so not sure ..... Is there any advantage moving to fixed pressure machine other than cost?

Thanks

[palerider]

Thank you for your reply Pugsy. Makes complete sense and you're right in that I definitely started the night side sleeping.

The machine I've got has settings locked by the rental supplier ...

No, it doesn't, they're just in a hidden menu, go to the link at the top of apneaboard.com and read how to request the clinical manual via email.

It's also reporting back via it's modem so I'm a bit hesitant to change settings at the moment.

They probably are, who's paying who? they work *for you*.

I know my doc is keep to move me onto a CPAP machine set at the 95th percentile of the auto pressure over the rental period. .....

The only people that pay attention to the 95% numbers are those that don't know how to read a pressure graph.

I'm not sure how I feel about that ... The doc made a big thing about the machine being cheaper if it's CPAP and that apap can cause awakenings with pressure changes (I don't think it has for me personally).

Your doc seems rather uninformed.

Yes, a cpap is cheaper than an apap if you're paying cash... price is the same in the USA if you're using insurance.

As to people being waked up by pressure changes... it's much more likely that you're awakened by the *breathing events* and just say 'hey, I woke up, the pressure is higher, must be this damn auto"...

I have a nagging feeling I'm missing out on some customisation options if I change machine. I'm quite happy with the dreamstation apap in general so not sure ..... Is there any advantage moving to fixed pressure machine other than cost?

None at all, and you limit your future options.

[Bookit]

Be stubborn and stick with the dreamstation apap.

Your doctor doesn't know what he's talking about. Since you can't get good advice from the doc, you will definitely need help from the pros here (that's not me). And ultimately you are the one that has to sleep with the machine. You doctor does not.

My theory is that if doctors actually had to use the machines they give us, the industry would improve. At the very least the doctors would understand how the machines work.

[D.H.]

Be stubborn and stick with the dreamstation apap.

Your doctor doesn't know what he's talking about. Since you can't get good advice from the doc, you will definitely need help from the pros here (that's not me). And ultimately you are the one that has to sleep with the machine. You doctor does not.

My theory is that if doctors actually had to use the machines they give us, the industry would improve. At the very least the doctors would understand how the machines work.

Getting doctors who use it is a stretch. I did have a primary care physician who used one, but he wasn't the one prescribing the machine. He sent me to specialist for that (the same one he went to himself).

Getting technicians and DME employees who use it might be easier. They can simply recruit among their customers and patients and perhaps give a hiring preference to anybody who uses a CPAP compliantly.

[palerider]

My theory is that if doctors actually had to use the machines they give us, the industry would improve. At the very least the doctors would understand how the machines work.

That's not a theory, that's a fact!

[zoocrewphoto]

My theory is that if doctors actually had to use the machines they give us, the industry would improve. At the very least the doctors would understand how the machines work.

That's not a theory, that's a fact!

It sure is!

My sleep doctor has sleep apnea and uses a machine himself. He only prescribes full data auto machines, and has them start with a reasonable pressure range, not wide open.
My only needed change to the pressure range is to bump the minimum when I have a bad cough. Otherwise, I still use the original pressure range.