Newbie to Board, Same Old Problems...

[mvosborn]

Greetings to all,

So I have been using, or should I say, attempting to use, my APAP machine for a little over a year now. When I did my initial home sleep study, it came back that I have severe apnea. Cannot even remember the original number now, but it was somewhere in the 30's range. After receiving this info, I started doing a lot of reading, and looking into machines. There was no way I could do a titration study in the lab. I cannot sleep in a conventional bed, due to repeat back injury and subsequent surgery. I have slept in a recliner for about the last 5 or 6 years.....on my back. In my reading, i discovered the difference between, or what I perceived to be the difference between, the CPAP and the APAP. My assumption was, since the APAP was automatic, I would not need a titration study to be done, since the machine would automatically adjust to the correct numbers......Yeah.....never assume.
Anyway, I have been thrashing around with numbers all over the place for the past year. I can't even tell you exactly how I came up with the numbers I used. A year of failed trial and error...It is becoming very obvious to me that the lack of quality sleep is basically wiping me out, slowly but surely. I would be super pleased if I got results on occasion, below a 5. But then I would read results in this forum, of people that are actually displeased when they have results above a 1 or 2!!

So, that is what brings me here.....In reading information about newbies, I found that you all use the Oscar software. I have downloaded it now. Don't necessarily understand the results, but again, just started using it today. My hope is that some of you experts out there, can take a look, and hopefully give me some suggestions as to starting numbers, or something that will bring my results in line with what they should be. The two screenshots I have, are both from this month. The reason I chose these two is, I just cannot understand how two sets of results, on the same settings, can have such a wild swing!! I mean, seriously, as anyone else ever had results in the 70 range?

I would like to thank you all in advance, for staying with this long winded post, and any numbers and other settings you can suggest as a new point to start. I am in dire need of some quality sleep!!

Kind Regards,
Mike

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[Pugsy]

Wow....pretty impressive and marked difference in results at essentially the same settings.
So we wonder why such a big difference?

Need a bit more history....how many nights are more like the really obviously ugly nights or was this a random rare night?
Were you actually asleep during this ugly night?

Do you take any medications of any kind? If so, what?

Did you sleep decently the night with the AHI of 3ish?

Can you tell a difference in how you feel the next day with each result????

[mvosborn]

Thank you so much for the speedy response......

The ugly 78 night was by far the worst I ever had, from a numbers standpoint. I would have to say the it is much more common for me to have results in the teens and twenties, with a few thirties thrown in for good measure.....occasionally I will have a night in the 9 or 10 range, and I celebrate a night at 4....
Yes, I was actually asleep during the 78 night. I was shocked when I got up and checked my numbers.....but it certainly reared it's ugly head in early afternoon whilst I was dragging ass around the house.....I did sleep good with the night in the threes.
I can usually tell the difference between nights, as to how readily I rise in the morning, and or go back to sleep after pouring a cup of coffee and watching some TV.

By way of history.....

I am a 65, almost 66 year old male. Obese. I am retired, due to the medical disability with my back, mentioned earlier.

As far as meds, more than I would like to admit to.....

Fairly strong prescription pain meds
Meds for type two diabetes
Meds for blood pressure
Meds for thyroid
Meds for BPH
Blood Thinners

[Pugsy]

Fairly strong prescription pain meds

This is the one I am most interested in at this time.
What med exactly? What dosage? Do you take it on a prn basis or regular like clockwork? Meaning are there nights where you might not take it or as much of it?

Pain meds can suppress respiration in some people and your ugly night with a boat load of CAs/central apneas points to respiration suppression. They can also make the OSA side of things worse for some people meaning make it harder for the pressure to prevent the OAs and hyponeas....but mainly they can suppress respiration and end up causing an imbalance in carbon dioxide levels which are needed for the brain to realize the CO2 levels are high enough to tell the body to breathe. Your CO2 levels don't always get to where they need to be but sometimes they do like the night where the AHI was 3 ish.

Whatever is going on seems to be random which makes me wonder if dosage is a factor on you pain meds.

[mvosborn]

The pain med is Percocet, 10/325. Once every 4 hours, no more than 5 daily. Normally I use 5 daily. I purposely try NOT to take anything closer than 2 hours before bedtime.

[zonker]

The pain med is Percocet, 10/325. Once every 4 hours, no more than 5 daily. Normally I use 5 daily. I purposely try NOT to take anything closer than 2 hours before bedtime.

from webmd-

"Tell your doctor right away if you have any serious side effects, including: interrupted breathing during sleep (sleep apnea)"

https://www.webmd.com/drugs/2/drug-7277 ... al/details

on page two. dunno why it loads to page one.

[Pugsy]

Percocet is powerful but there are more powerful pain meds and 5 per day isn't a huge dose.
Plus you have some nights where you don't have a problem.
Now figuring out why or just how important it might be....million dollar question.

Our bodies don't always play by normal rules and do what is expected.

Forget the people who are striving for the AHI of 1 to 2 all the time.

How is your actual sleep quality? Feel rested the next day or just worn out?

One thing to try and I don't know if it will do anything or not but try turning Flex exhale relief off if you can.
Keep a record of when you take your meds...all day and not just near bedtime.

I assume you have a PCP if you are taking those meds.....have you talked with him about your cpap/apnea issues????

Go back the last 30 days....How many nights with AHI over 10? How many nights with AHI over 5? How many nights under 5 AHI?
Make a note as to percentage of CAs/Centrals vs OAs/hyponeas with those AHIs.

Are you always on your back in your recliner? Is the recliner more horizontal or more vertical like sitting up????

[mvosborn]

Pugsy,
Thank you for taking the time, and showing a true interest in trying to help someone in need...

So, my sleep quality basically sucks. Mornings are usually extensive time trying to snap out of the fog. Afternoon usually is calling for a nap. Not my preferred style...

Flex exhale relief is turned off.

I have spoken to my pain management doc about the apnea, since she is the one that referred me to the sleep study. Her answer is referring me back to the sleep study docs. I know darned good and well that the first thing the sleep doc would say is, you have to have a titration study done. As mentioned earlier, not something I can do...

As far as sleeping in the recliner, it is normally closer to horizontal. My upper torso would be elevated slightly, but not very much. On occasion, I will roll toward my side, but just slightly. Pretty hard to do in a recliner...

So I went back over the last 37 days of data. Results go something like this......

0 to 4.99 AHI 9 days
Of 180 occurrences, 37% were CA/CENTRAL, AND 62% were OA/HYPOPNEAS

5.00 to 9.99 AHI 15 days
Of 471 occurrences, 41% were CA/ CENTRAL, AND 58% were OA/HYPOPNEAS

10.0 to whatever. 13 days
Of 2292 occurrences, 41% were CA/CENTRAL, AND 58% were OA/HYPOPNEAS

Hopefully these numbers will be of help to you. Thank you again for your help!!

Mike

[Pugsy]

Oviously sorely limited on options here and what I propose is a hail Mary attempt.

I still wonder why some nights are horrible and some nights aren't horrible at all but you aren't having enough decent nights to ignore the crap nights.

You are still having a sizeable chunk of obstructive events going on and it wouldn't be impossible for the untreated obstructive stuff to be causing arousals/awakenings and some of the cental/CA stuff might be arousal related more than sleep related.
We are extremely limited with what we can do in terms of the central stuff with this machine but we do have some options available for the obstructive stuff and maybe...just maybe...if we can better deal with preventing the obstructive stuff the centrals will reduce to a not so horrible level. Worth trying since it's about all we can do with this machine. Ideally you get all this experimenting done in a sleep lab setting but life hasn't given us ideal here.

This is a hail Mary...something to try and I have no idea how much luck, good or bad, is going to be there for you.

Increase your minimum to 12.
Make sure Flex is turned off because these reports show Flex being turned on.
Maximum to 20
Make notes of when you take your pain meds as well as sleeping position. This is real important because we need to be able to figure out if there is any sort of relationship going on between good and bad nights.

[mvosborn]

Thank you very much. Will give that a go.....
So just for #%#% and giggles, I went back to the above gathered data, and looked specifically at the 9 days that were below 5 AHI. Below 5 for me is a big win.
Of those 9 days, 1day was set at 10 and 20, and the remaining 8 were set at 11 and 20. All were with C-Flex turned on.....

Mike

[mvosborn]

So even though last night was a rough night for some reason, still had better numbers at 16.4. For me that is a big improvement over the last 10 days or so.
Will keep this current setting for a few days and see what happens....

Mike

[mvosborn]

So feeling a bit better today, although I had another rough night with nightmares and the like. Last night’s results better still with an 11.

[Pugsy]

So feeling a bit better today, although I had another rough night with nightmares and the like. Last night’s results better still with an 11.

How much of that 11 AHI is central and how much obstructive????

[supapat]

On 78' night ,i saw the abnormal on max pressure. Why pressure wasn't go above 12?

[Miss Emerita]

Pugsy, late to the party here. The chart for the horrendous night puzzles me: why doesn't the machine respond to the OAs by going above 12? The pressure graph looks as though it was for settings with a range of 11 to 12. Granted, PR machines are conservative, but this seems extreme.

Also, to mvosborn, did your home test show a breakdown of events into centrals, OAs, and Hs? There are limits to how accurately they can infer from the data they collect, but I'd still be curious what the results were.