newbie question

[Lilluanu]

I've been on CPAP for about 3 months now. I adjusted very quickly to wearing the mask and having the pressurized air, almost overnight. I'm comfortable with my mask, having the Resmed Mirage Swift II and LT to choose between (honestly I think I prefer the II even though I tend to be a side sleeper, the nose pillow on the LT is harder to adjust so it's sealed but not squishing my nose and it holds rainout in the corners no matter what I do - machine is on floor by bed and I use an insulated hose cover, with washcloths wrapped around the extra length of hose and the part of the hose on the mask to make sure no cold air can get to the sucker).

My pressure is very low (6) as my case is mild. My husband says I still stop breathing at night, and while the pressurized air does still inflate my lungs he says it does not seem quite as full a breath as I would normally take. He continues to lose sleep worrying about my breathing at night, though he can adapt to sleep debt much better than me for a variety of reasons.

My question is this: would asking my sleep specialist to increase the pressure on my prescription help, is this just how CPAP therapy works, or is there something else I could try that might be more effective? Are the continued pauses of breathing evidence of central apnea instead of obstructive? Any other input that might help?

[Julie]

There are other, more complicated answers you'll get now, and I'm sure most will be valid, but for right now, until you've learned more, I'd see how quickly I can get to your MD and tell him what your husband said, i.e. you think you'd like to try a higher pressure. Six is really low, mild or not (condition-wise) and I'd be surprised if it did the whole job. As well, has your husband said you sleep with your mouth open at all? If so, that would explain the lack of therapy, as the air being pumped in would be going straight out again, rather than into your lungs (though you say you think they're inflating). The reason for the pumping is not to inflate your lungs, of course, but just to help open the obstructed breathing passage in your throat formed either by anatomy (for some of us) or by your tongue falling backward and blocking it while you sleep. If you need a "full-face" mask (one covering your mouth a well as your nose) then it's worth experimenting by using 3M micro- or tranpore tape (light, easy to peel and available at most drugstores) overnight across your lips to keep them sealed.
Some other answers will address the need to be able to track your own therapy on the computer, using software and a special smart card, depending on what machine you're using, or learning to reset your pressures yourself, but that's probably not the best way to start out til you know a bit more (though it's really easy and we all do it . Ask your MD for a copy of the whole sleep study (not just the summary) as it's yours by right and because it will come in very handy in future if/when you decide to do the tracking.

[RipVW]

Sounds like you've been started just as I was, with an S8 Compact that is not data capable, and with a very low titrated pressure of 6. I spent a year like that before I found this forum, learned about data, got an auto machine, found my true pressure need (12). My sleep doc and RT were no help, though I'm sure other docs and RTs might be very helpful. I agree that you should report this to your doctor and go from there.

[Wulfman]

Yep. What Julie and Rip said. The air from the machine doesn't inflate your lungs......it's supposed to be enough to splint your airway open so your natural breathing will inflate your lungs. And, the pressure is not related to the severity of your apnea......it's supposed to be the amount needed to keep your airway open.
You NEED to get a copy of your sleep study AND a data-capable CPAP machine if you want to have successful therapy. The sleep study may show if there was any evidence of Central apneas and why it was determined that your pressure was set where it was.

Mouth-leaking (or mouth-breathing) will nullify your therapy. The "continued pauses of breathing" is a clue that your therapy is not working as it should be.......however, the cause is not necessarily "Centrals" (highly unlikely at that pressure) and needs to be determined.......and a non-data-capable machine doesn't help at all.

Den

[Lilluanu]

just got back from a week out of town, I will call the sleep doc tomorrow and see what he says. I actually already have the results from my PSG (they gave me copies of everything at my next appointment with the sleep specialist) and will scan them in at work tomorrow to see if anything therein can help those of you with more experience see what questions and comments might best help me in communicating the problem to the sleep doc.

In glancing over the charts, I didn't show any central apneas during the initial PSG but I did have one 10.4 sec central apnea (the only apnea of any type I experienced) during the titration study. Also, my PLM and spontaneous arousal indexes increased in the titration study from what they had been in the initial PSG. I dunno if any of that is normal or might offer further clues, but I'll scan the complete documents hopefully tomorrow.

I initially wanted a data-capable machine (hubby and I are both pretty big geeks and I wanted to be able to see what was happening with my therapy) but the RT talked me out of it, saying with my mild case and low pressure that it would be excessive and unnecessary.

**edited to add: to my knowledge I do not mouth-breathe at night, hubby would certainly have mentioned the noise if I were because it would irritated the heck out of him.

[JZ]

I initially wanted a data-capable machine (hubby and I are both pretty big geeks and I wanted to be able to see what was happening with my therapy) but the RT talked me out of it, saying with my mild case and low pressure that it would be excessive and unnecessary.

You have already proven the RT wrong. It is great that you have a mild case of SA, but who knows if your low pressure is the right pressure. Titration PSGs often get the pressure right, but then again they are off the mark often enough to warrant being able to capture ongoing data. And over time, one's needed pressure can change based on various factors.

I'm a little dumbfounded by the concept that monitoring one's health and therapy is "excessive" and "unnecessary." I really hope your sleep doc will agree with you that ongoing monitoring would be wise. Good luck.

Janna

[JZ]

Lilluanu,

Oh, my. I just realized I am not done ranting about your RT's comments. For a moment, let's just assume the worst case scenario -- that your therapy is not working properly and is not controlling your mild sleep apnea. Perhaps it is unnecessary to find that out and correct that. After all, you only have a mild case. What's the worst that can happen? Maybe someday your uncontrolled sleep apnea will contribute to a MILD case of high blood pressure, or maybe a MILD heart attack, or even a MILD stroke. Maybe you will suffer some MILD cognitive deterioration. Maybe you will be MILDLY less productive at work or home. Perhaps you will only occasionally nod MILDLY to sleep while driving. How about a MILD weight gain? A MILDLY increased risk for diabetes?

Lilluanu -- you are lucky to have a great husband who is far more concerned about your health than the RT. (I'm not knocking RTs in general, but this RT was way off base). It is your health and you should be able to have access to the non-excessive and necessary information to know if it is working properly. Please let us updated. You have a tremendous source of support and technical assistance on this forum.

Janna

[Lilluanu]

Scanned in PSG reports as editable text, graphs didn't carry through and of course formatting vanished when i cut/pasted, but here's the basic idea. Hope it's not too much gibberish, I was having trouble finding a way to host the images as .tif or .pdf so they would be accessible here.

KIRON Overnight Polysomnogram
SLEEP DISORDERS CENTER
Patient: (Lilluanu) Date of lab visit: 4/30/2008

HISTORY
The pt. is a 27 year-old woman with a BM" of 35, snoring, observed apneas, fatigue arid excessive daytime sleepiness. Order for PSG study with consultation to follow.
DESCRIPTION
The study was an attended overnight polysomnogram study using digital equipment, Recorded channels include EEG, chin, and leg EMG, body position monitor, chest and abdominal strain gauges, oral/nasal airflow, snore monitor, pulse oximetry and EKG.
The total recording time is 395.5 minutes; the total sleep time is 350 minutes, yielding a sleep efficiency of 88.5%. Of the sleep time, 2.6% is stage I, 50% is stage 2, 28.6% is slow wave sleep (stages 3 & 4), and 18.9% is REM.
There are a total of 0 obstructive apneas and 29 obstructive hypopneas; The RDI is 5.0 events per hour of sleep. The supine RDI is 7.8. in addition, the snoring event associated arousal index is 8.6 events- per hour of sleep. There are no oxygen desaturation events,
INTERPRETATION
I, There is physiologic evidence of mild severity obstructive sleep apnea with an overall RDI of 5.
2. The results of this study will be discussed with the patient at the time of her consultation at Kiron Sleep Disorders Center on 5/9/08.

Michael L Soo, M. D. Medical Director


Nocturnal Polysomnography Report
Pt. Name: (Lilluanu) Recording Date: 4/30/2008 Kiron ID: K8811
Date of Birth: BMI: 35.6 Weight: 224 lbs
Sex: Female (Body Moss Index) Height: 66.5 inches
Age: 27 Years or 395.5 min
Total Recording Time: 6.6 hrs
Lights Off: 22:24:23
Sleep Onset: 22:29:23 Lights On: 4:59:53
Actual Range, %TST Normal Range
Total Sleep Time (TST): 350 min 430+/-20 min
Sleep Latency: 5 min 13+/-10 min
Wake After Sleep Onset (WASO): 40.5 min 2+/-2 min
Sleep Efficiency: 88.5 % 96 +/- 2%
Wake: 45.5 min 16+/-4 min
Stage 1: 9 min 2,6 % 18 +I.. 10 min
Stage 2: 175 min 50.0 0/0 226+/-25 min
Slow Wave (Stage 3+4): 100 min 28.6 % 76 +/- 29 min
REM: 66 min 18.9 % 109 +I- 16 min
# of Events events / hr sleep
Respiratory Disturbance Index (RD): 5.0 <5hr.
Apneas: 0 0.0
Hypopneas: 29 5.0
Respiratory Associated Arousals: 77 13.2 <5hr.
Limb Movements: 23 3.9
Period Limb Movements: 4 0.7
Limb Movement Arousals: 17 2.9 <5hr.
Periodic Limb Movement Arousals: 1 0.2
# of Events ,% of total events
Central Events 0 0,0%
Mixed Events 0 0.0 %
Obstructive Events 29 100.0
Mean duration longest event
Obstructive Hypopnea 18.1 sec 29.8 sec
Obstructive Apnea
Central Apnea - sec
- sec - sec
sec

Nocturnal Polysomnography Report
Patient ID; K8811

Apneas
0 (removed chart due to extreme lack of formatting carryover)

Hypopneas
Side Supine Prone Upright Total
Stage Number Index Number Index Number Index Number Index Number Index
Wake M 0.0 0 0.0 0 0.0 0 0.0 1 0,0
1 0 0.0 0 0.0 0 0.0 0 0,0 0 0.0
2 6 3.6 8 6.4 0 0.0 0 0.0 14 4.8
S 2 2.1 0 0,0 0 0.0 D 0.0 2 1,2
REM 6 9.0 6 13,8 0 0.0 0 0.0 12 10.9
Total 1 4.4 14 7.8 0 0.0 0 0.0 29 5,0

Apneas + Hypopneas
Side Supine Prone Upright Total
Stage Number Index Number Index Number Index Number Index Number Index
Wake 1 0.0 0 0.0 0 0.0 0 0.0 1 0.0
1 0 0.0 0 0,0 0 0.0 0 0.0 0 0.0
2 6 3.6 8 6,4 0 0.0 0 0.0 14 4.8
S 2 2.1 0 0.0 0 0.0 0 0,0 2 1.2
REM 6 9,0 6 13.8 0 0.0 0 0,0 12 10.9
Total 15 4.4 14 7.8 0 0.0 0 0.0 29 5.0

AROUSAL SUMMARY
Number of Spontaneous Arousals: 72 Spontaneous Arousal Index; 12.3
Number of Apnea Arousals: 0 Apnea Arousal Index: 0.0
Number of Hypopnea Arousals: 27 Hypopnea Arousal Index: 4.6
Total Apnea + Hypopnea Arousals: 27 Apnea+Hypopnea w/ Arousal Index; 4,6
Number of Snoring Arousals: 50 Snoring Arousal Index: 8,6
Number of Desaturation Arousals: 0 Desaturation Arousal Index: 0.0
Total Respiratory-Related Arousals; 77 Respiratory-Related Arousal Index (RAI): 13.2
Number of Limb Movement Arousals: 17 Limb Movement Arousal Index; 2.9
Number of Periodic LM Arousals:
1 Periodic LM Arousal Index: 0.2
Total Number Arousals: 167 Total Arousal Index: 28.6



Lowest Desaturation; 0.0 % Number of Desaturations Below 85%: 0
KIRON
SLEEP DISORDERS CENTER

Overnight Polysomnogram with
CPAP titration

Patient: (Lilluanu) Date of lab visit: 5/8/2008

HISTORY
The pt. is a 27 year-old woman with mild severity USA with an RDI of 5 and excessive daytime sleepiness.
DESCRIPTION
The study was an attended overnight polysomnogram study using digital. equipment. Recorded channels include EEG, chin and leg EMG, body position monitor, chest and abdominal strain gauges, CPAP airflow, snore monitor, pulse oximetry and EKG.
The total recording time is 407 minutes. The total sleep time is 332 minutes, yielding a sleep efficiency of 81.6%. Of the sleep time, 5.1% is stage I, 38.9% is stage 2, 36% is slow wave sleep (stages 3 & 4), and 20% is REM.
CPAP titration is started at 4cm of water pressure with a high pressure of 8cm. At 4, 5, 6 and 8cm, the RDI is 0. At 7cm, the RDI is 1.2. REM sleep is noted at 5, 6 and 8cm.
The study is well tolerated with nasal pillows and a heated humidifier.
INTERPRETATION
I: There is significant improvement of obstructive sleep apnea with CPAP from 4 to 8cnn of water pressure. I would recommend a trial of CPAP at about 6cm of water pressure, as tolerated.
2. The results of this study will be discussed with the patient at the time of her consultation at Kiron Sleep Disorders Center on 5/9/08.

Michael L. Soo, M. D. Medical Director


Nocturnal Polysomnography Report
Pt. Name: (Lilluanu)
Date of Birth:
Sex: Female Recording Date:
BMI:
(Body Mess Index) 5/8/2008 Kiron ID:
35.6 Weight:
Height: K8811
224 lbs
66.5 inches

Age: 27 Years
Total Recording Time: 6.8 hrs or 407.0 min
Lights Off: 22:18:14
Sleep Onset: 22:52:44 Lights On: 5:5:14
Actual Range %TST Normal Range
Total Sleep Time (TST): 332 min 430 +/- 20 min
Sleep Latency: 34.5 min 13 +/- 10 min
Wake After Sleep Onset (WASO): 40.5 min 2 +/- 2 min
Sleep Efficiency: 81.6 % 96 +/- 2%
Wake: 75 min 16 +1-4 min
Stage 1: 17 min 5.1 % 18+/- 10 min
Stage 2: 129 min 38.9 % 226 +/- 25 min
Slow Wave (Stage 3+4): 119.5 min 36.0 76 +/- 29 min
REM: 66.5 min 20.0 % 109-/-16min
# of Events events / hr sleep
Respiratory Disturbance Index (RDI): 0,2 <5hr.
Apneas: 1 0.2
Hypopneas: 0 0,0
Respiratory Associated Arousals: 9 1.6 <5hr.
Limb Movements: 46 8.3
Period Limb Movements: 12 2.2
Limb Movement Arousals: 33 6.0 <5hr.
Periodic Limb Movement Arousals: 11 2.0
# of Events 1° of total events
Central Events 1 100.0 %
Mixed Events 0 0.0 %
Obstructive Events 0 0,0%
Mean duration longest event
Obstructive Hypopnea
Obstructive Apnea
Central Apnea - sec
sec
10.4 sec - sec
- sec
10.4 sec



Nocturnal Polysomnography Report Patient ID: K8811

Apneas
Side Supine Prone Upright Total
Number Index Number Index Number Index Number Index Number index
Wake 0 0,0 0 0.0 0 0.0 0 0.0 0 0.0
1 0 0.0 0 0.0 o 0.0 0 0.0 0 0,0
2 0 0.0 1 0.7 0 0.0 0 0.0 1 0.5
S 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
REM 0 0.0 0 0.0 0 0,0 0 0.0 0 0.0
Total 0 0,0 1 0.3 0 0.0 0 0.0 1 0.2

Hypopneas
Side Supine Prone Upright Total
Stage Number Index
Number Index Number Index Number Index Number Index
Wake 0 0.0 0 0.0 0 0.0 0 0,0 0 0.0
1 0 0.0 0 0.0 0 0,0 0 0,0 0 0,0
2 0 0.0 0 0.0 0, 0,0 0 0.0 0 0.0
S 0 0.0 0 0,0 0 0,0 0 0.0 0 0.0
REM 0 0,0 0 0,0 0 0.0 0 0,0 0 0.0
Total 0 0.0 0 0.0 0 0,0 0 0.0 0 0,0

Apneas + Hypopneas
Side Supine Prone Upright Total
Stage Number Index Number Index Number Index Number Index Number Index
Wake 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
1 0 0,0 0 0,0 0 0.0 0 0.0 0 0.0
2 0 0.0 1 0.7 0 0.0 0 0.0 1 0.5
S 0 0.0 0 0.0 0 0.0 0 0,0 0 0.0
REM 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0
Total 0 OM 1 0.3 0 0,0 0 0,0 1 0.2

AROUSAL SUMMARY
Number of Spontaneous Arousals: 123 Spontaneous Arousal Index: 22,2
Number of Apnea Arousals: 1 Apnea Arousal Index: 0.2
Number of Hypopnea Arousals: 0 Hypopnea Arousal Index: 0.0
Total Apnea+Hypopnea Arousals; 1 Apnea*Hypopnea wl Arousal Index: 0.2
Number of Snoring Arousals: 8 Snoring Arousal Index: 1.4
Number of Desaturation Arousals: 0 Desaturation Arousal Index: 0.0
Total Respiratory-Related Arousals: 9 Respiratory-Related Arousal Index (RAI): 1,6
Number of Limb Movement Arousals: 33 Limb Movement Arousal Index: 6.0
Number of Periodic LM Arousals: 11 Periodic LM Arousal Index: 2.0
Total Number Arousals: 176 Total Arousal Index: 31.8

Lowest Desaturation: 0.0% Number of Desaturations Below 85%: 0

[JZ]

Bump


Lilluanu -- do you have some specific questions about your PSG data you posted? I would be out of my league addressing those, but there are many here on the forum who are extremely knowledgeable. So feel free to ask questions.

[Lilluanu]

I posted the PSG data to hopefully shed more light on the issues from my original post. I did not get a chance to call my sleep doc yesterday but I should be able to do so today, and I wondered if perhaps the community here could help suggest questions and comments to best shed light on the problem so he will understand what is going on.

My question is this: would asking my sleep specialist to increase the pressure on my prescription help, is this just how CPAP therapy works, or is there something else I could try that might be more effective? Are the continued pauses of breathing evidence of central apnea instead of obstructive? Any other input that might help?

[Lilluanu]

Talked to sleep specialist and DME, they adjusted my pressure up to 7 yesterday, and the RT is putting together some cost information for me to trade back my current Resmed S8 Compact for either a Resmed Elite II, a Resmed Autoset II, or a Respironics M Series Pro (for which I would also have to buy a new humidifier of course). I also got a copy of my prescription from her so I can send it in to CPAP.com in case I find an auction machine that would suit my needs. I was wondering if anybody who uses any of these 3 machines could offer feedback to help me choose?

I am interested in the Respironics despite the added cost of another humidifier because I have heard that I cannot get the software for the Resmed data capable machines to download and monitor at home (which I very much want to do), whereas Respironics has the Encoreviewer software available to patients?