Finally took the test...

[zrob]

Something to think about since you are going to be adding Oxygen...make sure you still need it once the sleep apnea is optimally dealt with.

This is what I figured. I would probably only need it for a certain duration, but even at the rate Crapria wanted to charge me, a couple months and I could buy one outright...which I did. I think I paid $350 and it had only 500 hours on it.

I am to follow up with my doctor in a month from starting treatment. I bet he will probably suggest another sleep study to see how I am doing, unless he just goes off the results he gets from ResMed.

[zrob]

The PS of 8 is likely the cause of the high number of central/CAs.

Pugsy, I can't thank you enough. I think lowering that PS and changing to the small size nasal thingy worked some magic. Still need to work on leaking, but this looks better than my first night. I am finding that I want to way oversleep. Maybe because I am actually getting good sleep?

[Pugsy]

We don't need that top AHI graph but we do need the Events graph.
The AHI graph is just an hour by hour index and we can see pretty much on the Events graphs if there is much clustering of events to equal a higher hourly average.

Last night was much better for sure though.

Keep the current settings for 2 or 3 more nights so you can get used to them and if we still see the OA/Hyponea count where it is now maybe try 1 cm more minimum EPAP.
I prefer to go up slowly and give things a bit of time for your body to adjust because there is some truth to the "give it time" thing. We don't sleep the same each night for one thing....and it does take some time to sleep soundly with all this crap on our faces and limit chance of awake breathing false positives.

You had about 45 minutes of large leak from unknown source. Again could be mouth opening or just mask movement.
Not the end of the world though and not unexpected for a second night. I suspect mask movement because that's an awful lot of leak for just mouth breathing.
After about a week or so and after you are more adjusted overall to the whole process if you are still seeing blocks of leaks like this then we might consider taping the mouth shut for one night to see if it helps or not so we can know for sure what the leaks are from and deal with accordingly. I don't think it is bad enough to just have to do that right now and I don't want to add more "stuff" on your face to probably mess with comfort and sleep. It's not urgent in other words.

And yes, the body tends to want more sleep once it is actually getting it because it knows it needs it and likes it.
It wants to play catch up a bit. Quite common really. In time this should level out a bit as your body heals from the damage done by the apnea. You didn't get this condition overnight and it's not going to resolve or let your body heal overnight either. There's long term damage that needs to get a chance to heal.

It will get easier and better....I promise you that.

As far as masks and leaks...we might need to consider a different mask at some point if we find that this one just moves around too much and you can't stop it and if it wakes you up a lot. That is common also. Most people have to go through several masks until they find one that suits them the best.

With facial hair you might do better with one of the mask types that use nasal pillows rather than the cushion type which does have to contact the facial hair under the nose.
The nasal pillows contact the nostrils more and don't rely so much on skin to cushion contact below the nostrils where most facial hair is.
Nasal pillows also tend to be more stable and less likely to just move around with movement or whatever.

[Pugsy]

Hi, May I ask which brand CPAP machine you are using?

Look at the posted reports from the machine.
Brand and model clearly stated along with settings and other useful information.

[Pugsy]

You know I have been thinking about the doctor ordering PS of 8 and the only remote reasoning might be because of your low O2 numbers and he is thinking that a higher PS might push more oxygen via bigger breaths.
Doesn't really work that way though and he might not understand what can happen sometimes with those bigger PS inhales.

You have to understand some back information first as to what actually triggers the brain to send the "breathe human" signal to the body. It's carbon dioxide levels that are the trigger and not O2 levels which is what a lot of people think.
The carbon dioxide levels in the blood need to be a certain higher setting for the brain to tell the body to breathe.
When a higher PS is used the carbon dioxide levels in the blood get "washed out" too soon and never get high enough for the brain to think "OMG my human needs to take a breath". Higher PS makes a person sort of hyperventilate and keeps the carbon dioxide levels below the threshold where the brain wants to tell the human to inhale.

This wash out effect can happen with any PS really and isn't limited to higher PS but it is more common with higher PS.
Just another one of those YMMV things that come with all this sleep apnea/cpap stuff.
It's something that can happen when any bilevel setting is used ...evenly lowly EPR exhale relief of 1 cm can do it to some people. It's rare for sure but it can happen.

Normally a higher IPAP number will help with oxygenation but sometimes how we get that higher number actually causes more problems and increasing PS while increasing IPAP dramatically....also increases the chance of central apneas in some people. A better solution for increasing IPAP in those people might be increasing the minimum EPAP which then forces IPAP up if just looking for oxygenation increases.

Your doc may have been thinking using higher IPAP to help with oxygenation but not taking into account the washout effect that sometimes happens.

[zrob]

You know I have been thinking about the doctor ordering PS of 8 and the only remote reasoning might be because of your low O2 numbers and he is thinking that a higher PS might push more oxygen via bigger breaths.

This could very well be what he is thinking. I'd ask him, but I don't want the drama of me questioning him. All I know is my ears are not bad this morning and I feel like I slept better than my first night. I will give this a couple days and if the leaks continue, I will have my wife work some magic and tape my mouth shut. I have also been looking at different masks and I think I have landed on the next one to try. The DreamWear with Pillows. I do recall waking up a couple times in the middle of the night to move the hose around some pillows, so I am thinking that having the port on the top of my head might be better and the nasal pillows might work better with me having upper lip hair.

Also, I should have all the equipment to start using the oxygen tomorrow night.

[Pugsy]

There's really no need to discuss PS with your doctor unless he notices that PS is at 4 on the reports he sees and wonders about it.
If he does then you can discuss it with him at that time...explain the ear issues as well as the onset of a high number of centrals from carbon dioxide wash out. I don't know that I would harp on "someone on the internet told me.....xxxx" or not as doctors tend to roll their eyes at that but you can say you did some research and came up with that reasoning.
Also that EPAP of 4 wasn't enough to hold the airway open and prevent the collapses.
Scientific documentation for what I offer is available in medical journals....after all I got it from somewhere.
I didn't just pull it out of my butt. So lots of reading and lots of experience is what I draw upon.
The doc may not appreciate my work though. They are funny about stuff like that but if he is any good at all he will be happy that we found a workable solution for you rather quickly.

[Miss Emerita]

Very good to read that things are coming along. If you try taping, you might want to invest in a box of Somnifix strips just to start with. They are pricey but quite gentle on the skin and hold well (except if there's a lot of saliva creeping out to loosen the bond). After that you can experiment with less expensive tape that you can cut to size. Be sure to fold over a piece at one end to make a tab your can easily grab for removal.

[zrob]

There's really no need to discuss PS with your doctor unless he notices that PS is at 4 on the reports he sees and wonders about it.

Can they remotely update it back to what it was before?

[loggerhead12]

Can they remotely update it back to what it was before?

Yep, although it rarely happens. Oddly enough, the pressure settings are way down the list of things that the DME and doctor are concerned about. The highest priority is making sure that you wear if for at least 4 hours a night, as though that's going to fix your sleep problems.

[Pugsy]

It's Crapria we are talking about for a DME....
While it is possible to remotely change a setting...probably more work and skill levels needed than anyone at Crapria has.
Easy to change back if they do though. Just watch your settings at bedtime and maybe verify they are what you made them. Any changes they might make would be done during their business hours and not in the evening or night at bedtime.
To be honest I doubt they will even notice because the main thing they will look at is hours of use.
All that they really care about is getting paid in a timely manner by the insurance company if the insurance is paying for something.
Besides...they don't know if the changes made were by you or you at your doctors direction.

If insurance isn't involved for some reason you can always put the machine in airplane mode which would put a stop to any remote changes but it also means no transmission of the hours of use data as well to prove you are using the machine the minimum number of hours to keep the insurance company happy.

[zrob]

It's Crapria we are talking about for a DME....

Not really sure how much the insurance company is paying since what I was told was Crapria will charge me $150/month for 10 months and then the machine is mine. Seems more like a line of credit more than anything, seeing that the machines are around that price.

[Pugsy]

It's Crapria we are talking about for a DME....

Not really sure how much the insurance company is paying since what I was told was Crapria will charge me $150/month for 10 months and then the machine is mine. Seems more like a line of credit more than anything, seeing that the machines are around that price.

Sounds like you have a high deductible and insurance probably isn't paying much if any.
You would need to verify with your insurance company exactly what all is involved on their end.
Don't ever, ever rely on what any DME tells you about what your insurance requires or is doing.....it's impossible for DMEs to know exactly what each insurance plan will do or pay or requirements. That's the golden rule about DMEs no matter what insurance a person has.
Does make me wonder just how much they are billing out for the machine if your portion of the cost is 1500...that sucks.
They can be found any day of the week on the internet for between 1200 and 1700 (for brand new) and screw insurance.
And don't let them tell you that you have the buy the machine from them to get masks because that's a big lie as well.
My insurance has never paid for a machine for me and I use a DME for masks and let insurance buy masks or I used to until my DME decided they didn't want to supply the mask I wanted so I told them where to go and buy my own.
12 years on cpap....more machines than I can count because I just like to experiment...and never used my insurance.
Always bought private purchase for less than what my co pay would be if I had used insurance...and I didn't have to answer to anyone. Priceless.

[JLROhio]

Hi, May I ask which brand CPAP machine you are using?

If you were unable to find it on the screen shot that the OP provided (it's sorta small and unreadable unless you blow up the view)...

It is a ResMed AirCurve 10 VAuto

[bwexler]

For what it's worth my Sleep Study AHI was only 83.
Now when I see AHI above 2, it means I have had a bad night. I have had many nights at Zero AHI.
I have had 3 machines over the past 11 years.
I have seen about half a dozen sleep specialists.
Pugsy helped me get started and along with a very knowledgeable group on here have provided more and better advice than all the specialists I have seen. I have periodically done the opposite of what the doc recommended and gotten great results.

When it comes to masks I have only used a couple dozen and I am certain someone will invent the perfect mask for me someday soon.

I was going to recommend you get the Resmed hose with the oxygen injector port near the machine connection. But I was too slow. You already ordered it.
I also recommend you get a long enough O2 tube to put the concentrator in another room. The concentrators are noisy. slightly less than a diesel locomotive or a Mac truck.

And for Pugsy I knew ONE respiratory therapist at Crapria who was very good and helpful. She retired a few years ago.