1st 30 days--need advice B4 Dr appt

[TinkRBell]

Hi everyone,

I've been lurking as a guest the past month and first want to say THANKS for all the great info/advice out here.

I've reached the point where I need some advice from the veterans. I'm a little over 30 days on my CPAP, and my AHI numbers aren't anywhere close to where I think they need to be ... averaging around 13.1 most nights. I have a PRS1 Remstar Plus with A-Flex CPAP. I started out with a nasal pillow mask but was a big mouth breather so they changed me to a full face mask after Week 2. The doc also gave me a 15-night supply of Ambien CR but I haven't had any since. I'm uploading last night's graphs plus the 30-day overview.

So my question for you is, when I see the doc on Tues what should I expect/press for? Would I be better off taking Ambien all the time and/or do I need a different machine? I seem to be having a huge amount of clear airway apneas every night, and I'm having almost no OSA activity. Here are the URLs to my Sleepyhead graphs (have tried unsuccessfully to embed them here...)

http://s1125.photobucket.com/albums/l58 ... DDec10.jpg

http://s1125.photobucket.com/albums/l58 ... erview.jpg

THANKS!

[Lizistired]

If you click on "IMG code" it will say "copied" and then paste here.

[Lizistired]

I would ask if you might do better on a cpap pressure. I'm not that familiar with your machine or sleepyhead for that matter, but I don't see why your pressure is increasing. Many of your CAs seem to start when th epressure increases. Just my 2 cents.

[Pugsy]

I have a PRS1 Remstar Plus with A-Flex CPAP

To avoid confusion later ...the machine you are currently using is the PR System One Remstar Auto CPAP with AFlex.

You need to discuss those clear airway events with your doctor. Way too many of them.
Ask if you had any centrals during either your initial sleep study or the titration sleep study.
Your pressures are far from high. The machine will respond to the obstructive components so that probably explains the slight increase in pressure. The machine won't do a thing for those clear airway events nor is it designed to.

From this report, if it is typical for you, the clear airway events need to be addressed. I don't think we can blame them on the Ambien.

[rested gal]

TinkRBell, you're getting good advice here.

To follow up in the direction Pugsy is heading (and rightly so, imho) you do need to question your doctor closely about whether many "central" apneas showed up in your sleep study in the sleep lab.

Especially ask the doctor if MORE central apneas popped up during the titration part of your sleep study (when the CPAP mask was put on you and the sleep tech was adjusting pressure) than during the diagnostic part of the study when no CPAP was being used.

[TinkRBell]

Thanks everyone. I went back and looked at my initial study and my titration study. I had 71 apneas in my original study, 61 centrals and 10 OSAs. In the titration study, I only had 4 apneas, 3 OSAs and 1 central. Now I'm really baffled as to why I'm having so many CAs at home.

[archangle]

Zoom in on your central apneas. See how long they last, and are they complete or partial cessations of breathing. Don't panic about a moderate number of "centrals" until you see how long and severe they are.

See if you get any of these apneas at 6 cmH20 pressure. See if pressure goes up and then you get apneas or the other way around.

Does your snore graph show anything?

Liz has a good idea. Try manual CPAP at a few different pressures and see what happens.

[TinkRBell]

My snore graph is almost zeroed out every night. I think I had 2 whole snores the entire night of 10 December.

I will have to zoom in on the CAs when I get home tonight and can look at SleepyHead.

THANKS!

[cre8vmynd]

Do you suffer from insomnia? Does your sleep feel very light and fragmented through the night?

I had a lot of CA's when I first started but figured out (thru the questions and comments of other users) that my chronic insomnia and sleep fragmentation were making it look like I had a huge amount of CA's.

Since addressing that, my CA's have REALLY dropped off.

I know this doesn't answer your initial question but I wanted to share anyway.

Casey

[TinkRBell]

Casey,

I do have problems with light sleeping/fragmented sleeping. I also have problems with latency -- it took me 80 minutes to fall asleep during my first sleep study, and even at home some nights it takes this long.

How did you address this problem?

[Pugsy]

I do have problems with light sleeping/fragmented sleeping. I also have problems with latency -- it took me 80 minutes to fall asleep during my first sleep study, and even at home some nights it takes this long.

How did you address this problem?

You try to figure out whatever the cause might be and try to fix it. If some external factor like pain or bed comfort...then obviously try to fix it as best you can.
If it is the well known insomnia monster who visits for no apparent reason then we try to keep him away.
Various methods include eliminating any possible triggers or bad sleep hygiene habits to possible sleep aids (always discuss with your doctor).
Taking a good long hard look at sleep hygiene is a starting point.

[cre8vmynd]

TinkRBell,

As Pugsy stated, definitely look at sleep hygiene first. If you're not sure what that entails, a quick search will provide more than enough info.

I had to do multiple things to help my sleep. I have had sleep onset and maintenance insomnia for the last decade. Here's what I did:

(1) I got on xpap, which you've already done.

(2) Cut WAY back on stims. For me it was coffee, tea and for a while, Ritalin. I now only have a couple cups of coffee or tea and never after mid afternoon. Stims can wreak havoc on our stress hormones that can interfere with sleep.

(3) Implemented good sleep hygiene and try to do it every night.

(4) And the thing that REALLY helped me was something called Sleep Restriction Therapy. Again, if you're not familiar with the term, just do a quick search. I'll tell you, it was brutal at first, but after that first night of falling asleep within 15 minutes, and sleeping a solid 5 hours (both of which were unheard of for me) I knew that was my ticket.

And my sleep has gotten better and better each week. I've only been on xpap 8 weeks by the way.

Casey

[TinkRBell]

Thanks again everyone. Saw the doc ... he wasn't willing to go to straight CPAP yet, but he lowered the upper end of the range for my a-flex considerably and says we need to work on my sleep consolidation. Apparently the CAs are very short in duration but they're going on like crazy and not helping me wake up feeling rested. Plan A is to try to see if Lunestra can help with the SC, then work to eventually taper me off that. Off to the next 30 days of my adventure. Appreciate all the inputs, helped me ask smart questions at my appt

[Pugsy]

Sounds like a good solid plan. Gotta start somewhere.

I also have problems with sleep fragmentation. On going battle due to pain in my case and I keep whittling away at it and finally can sleep with minimal awakenings with a combination of things to help sleep and reduce pain.