Can someone help interpert my data?

[uriahsky]

I just don't know what all this means and what I should change if anything. I still wake with headaches. I know it has something to do with apnea but what can I possible change on my machine?
I have a Respironics PR System One REMstar BiPAP Auto with Bi-Flex.
It is set at:
EPAP: 4.0 IPAP: 14.0 cmH2OPS: 10.0.

The abrupt changes on the charts are because my sinus get blocked and I wake up every hour or two. If I drink some water my nose will clear and If I don't my head will start throbbing because of the pressure build up, because of the blocked sinus. I have tried everything including sinus surgery to clear turbinates to keep my sinus clear and my headaches down. I use a full face mask which I find works better then the nasal mask for me.

Is there something I am missing. I am not sure what these numbers are saying.
Thanks very much,
Russ

[cflame1]

Russ,
Your CA count is large... did you have centrals on your sleep study?

[uriahsky]

I hate to say this because people don't seem to understand the uninsured. I have never done a sleep study. It cost 2400.00 and I have tried saving for it but I just can't do it. The place that does them also isn't used to people not having insurance and they have no programs for me. I have had health problems all of my life and I am barely able to work part time. My whole family has issues. There is not a lot of financial support for people like me, males, working age, without major disabilities. I don't have anyone to help me with this type of thing. I know I have sleep apnea, you can see it on the charts. When it comes to sleep study I think I am going to have to wait until they have those little take home units that do a lot of what is needed which seem to be just around the corner. I have spent a lot of money on Doctors and am a bit gun shy because it seems most of the money was wasted. It seems when you see a specialist you pay the hundred plus dollars and they tell you to spend another 1K on tests and when I don't have that money there seems to be nothing else they can do. The only support I have are these forums. So thanks for any insight anyone has.
Russ

[cflame1]

ok... how did you come up with the numbers that you're using for EPAP/IPAP?

Are you taking some kind of medication? Sometimes medication can cause CA...

Are you using a humidifier or not? If so what is it set to? Do you usually have sinus issues?

[Pugsy]

Can't tell if those Clear airways or the real deal or if they are showing up during periods of awakening due to the breathing.
They do warrant concern until we can figure them out.

Your hyponeas and obstructive apneas and the snores are in large numbers because the EPAP is not quite sufficient to give the machine a good enough head start to deal with them most effectively. While normally we would look at IPAP for hyponeas...in this instance I wouldn't right now. Not with the clear airways until we can figure out if those are asleep events or awake (semi awake) or sleep onset events.

If this were my report I would make some rather drastic changes and go about things a little different to see if those clear airway (centrals) might be from the pressure and at the same time try to reduce the obstructive events.
I would increase EPAP to 6 and limit the maximum IPAP to 10. Use PS of 4 max. Let the machine roam between 2 and 4.
I would also make every effort to document in some fashion any awake time spent masked up because if some of those clusters are awake or semi awake events...then we have to totally discount those. When I see breaks in therapy line I know that there is some time again spent at sleep onset stage or even awake.
Heck, I might even just use straight bilevel mode and not have the auto adjusting feature enabled.

If these are pressure triggered centrals...we need to find a spot where the pressure is low enough to not trigger them and yet great enough to deal with the obstructive events. Unfortunately we have no way of knowing for sure if the pressure is causing it or if you would have them anyway (different diagnosis) or even if they are real and warrant concern.
So have to do some detective work to see if we can get an idea why they are there.

Do you spend a lot of time masked up and awake during the times that you see the large cluster of events?

[robysue]

Pugsy has offered some excellent advice. I too think that the min EPAP setting is too low. If bumping it up to 6cm seems like too much when you first try it, then first bump it up to 5 for a few days and then bump it to 6. Lowering the max IPAP to 10 for a while is also reasonable in light of the CAs. For the time being keep the PS setting at PS = Max IPAP - min EPAP so that the pressures are free to roam.

You say that sinus pressure is a big issue for you. And you use a full face mask. The FFM is a very reasonable choice under the circumstances. But even so, relieving the sinus pressure as much as possible is an importantpart of making BiPAP therapy both more comfortable and more effective. And you're also uninsured---so we need to keep that in mind too. But we need to know some additional information about your sinus problems.

1) Has a doctor of some sort given you a formal diagnosis of the sinus problems? If so, what was the diagnosis and what was the recommended treatment?

2) Are all of the sinuses involved? Or are one or two much more problematic than the others?

3) Is the sinus pain usually bilateral/symmetric (hurts on both sides of your face in the same location)? Or is it usually unilateral/nonsymmetric (hurts on one side of your face at a time---the side that hurts can switch though)? Where is the sinus pain/pressure worse? In your cheeks? Above the eyes?

4) Are the sinuses blocked because of nasal allergies? If so, what kinds of things are you allergic to? Do you have a well defined allergy season?

5) Has a doctor recently evaluated your sinuses and ruled out a chronic sinus infection of some sort? Have you had sinus infections diagnosed in the past? Have you ever taken antibiotics in order to eliminate a sinus infection?

6) How do your sinuses react to warm, humid air? In other words, does taking a hot shower help the sinus pain or make it worse?

7) When you bought the BiPAP, did it come with a heated humidifier? Are you using the humidifier? If so, what setting do you have it on?


You write:

I have tried everything including sinus surgery to clear turbinates to keep my sinus clear and my headaches down.

Can you give us a rundown of what "everything" includes? In other words, have you tried any of the following? Did they make any difference at all---even if it was just for a little while? Do you still do any of the following on a regular basis?

1) OTC antihistamine pills like Claritin, Zyrtex, Allegra, Benadryl?

2) OTC decongestant pills like Sudafed?

3) OTC pain medication like ibuprophen or tylenol?

4) OTC decongestant nasal sprays such as Afrin? (NOTE: You should only use something like Afrin for very short periods---after three days of use Afrin and other decongestant nasal sprays will trigger rebound congestion and you'll be worse off instead of better.)

5) an OTC nasal spray called NasalCrom? (Note: NasalCrom is for allergic rhinitis and is designed to be used on a long term, daily basis; it is NOT a decongestant nasal spray.)

6) OTC saline nasal sprays? (These can be used daily for long periods of time.)

7) OTC saline sinus rinses or neti pots?

8) Prescription allergy pills? If so, what kind and what dose?

9) Prescription steroid nasal sprays such as Flonase or Nasonex?

10) Prescription antihistamine nasal sprays such as Astelin?

[uriahsky]

Thank you so very much. I now have some kind of direction and perhaps hope. I have to read those replies a few times because I am not that familiar with the lingo of sleep apnea talk.

"Can't tell if those Clear airways or the real deal or if they are showing up during periods of awakening due to the breathing."

I am not sure I follow along with this statement. Is it related to the one below?

"Do you spend a lot of time masked up and awake during the times that you see the large cluster of events?"

Most of the time I am awake I take the mask off. I try and put it on right before I fall asleep and remove it if I wake up. I do that because of the fear of a blocked sinus pressure situation. I wake up about four times average a night and I think it is because of dehydration, needing to go to the bathroom, and the sinus pressure. I think that is why I wake up. When I do I take the mask off and wait until I feel I can breathe through my nose, and drink some water.

"I would increase EPAP to 6 and limit the maximum IPAP to 10. Use PS of 4 max. Let the machine roam between 2 and 4."

I will give this a try for a few days and report back and I will also try the straight Bilevel settings and see what happens.

ok... how did you come up with the numbers that you're using for EPAP/IPAP?
I bought this machine because I thought I wouldn't need to have to worry about the settings with "Auto" in the name. I put everything on max at one point because I couldn't find any info on how to go about figuring out the settings for this machine. I just set them to the current numbers from either a guess or reading what someone else did.

Are you taking some kind of medication? Sometimes medication can cause CA...
I am pretty much taking no kind of sedating medication. The only think I take at night is Imitrex because if I take it before I fall asleep I have a better chance of waking without a headache.

Are you using a humidifier or not? If so what is it set to? Do you usually have sinus issues?
Yes, I have the attached humidifier and I warm the water in the microwave before going to sleep to help with the initial coldness. I have tried every setting but currently it is on #3

When it comes to Sinus problems I have been down that road so many times. There were times were I was on antibiotics for almost a whole year trying to get rid of a sinus infection. I have to be real careful of everything because the minute I start to do something wrong it seems to lead to a difficult to overcome sinus infection.
Headaches that are severe and very painful and usually always come in the morning have been with me for the past 10-15 years. I had the turbinite reduction and that didn't really do anything that I noticed about five years ago.

1) Has a doctor of some sort given you a formal diagnosis of the sinus problems? If so, what was the diagnosis and what was the recommended treatment?
I can only really see a doctor when it gets bad and they just give me antibiotics based on what I say. I tell them the history and what works and they write a script. They sometimes say we can set you up to see a specialist but what happens is what I mentioned in my earlier post. You pay the specialist fee and they say "MRI, X-Ray, surgery, or more tests, and I say I can't afford that and they just say nothing and I leave. I have had an MRI years ago and that showed some sinus problems but nothing major if I remember right. This and the surgery was paid for when I was in such agony and almost homeless that I qualified for being medically indigent but I no longer qualify for that. It did seem that the headaches were not as bad at that time but over the last two years they have been coming back with a vengeance.

2) Are all of the sinuses involved? Or are one or two much more problematic than the others?
This is hard to tell, the only thing I sense is that the right nose is the first to get blocked.

3) Is the sinus pain usually bilateral/symmetric (hurts on both sides of your face in the same location)? Or is it usually unilateral/nonsymmetric (hurts on one side of your face at a time---the side that hurts can switch though)? Where is the sinus pain/pressure worse? In your cheeks? Above the eyes?
When I get an infection that is when I get this type of pain but I don't think I have an infection at this time. The headaches usually hurt all over my head and are worse than death. This is what I face almost daily. A thick feeling heavy head that requires me to rest in a chair after waking and can lead to or is a headache that takes all day to get over.

4) Are the sinuses blocked because of nasal allergies? If so, what kinds of things are you allergic to? Do you have a well defined allergy season?
At one time when I was young they said I was allergic to everything except bathroom mold. Currently I rarely have allergy symptoms, no watery eyes, no itching. I only get bothered when I put the sleep mask on. I start with clear breathing through my nose but after a few hours they start to plug.

6) How do your sinuses react to warm, humid air? In other words, does taking a hot shower help the sinus pain or make it worse?
It seems to help and one time a few months ago I did realize that I had an infection even though I didn't have any nasal discharge or any colored or plain mucus and I noticed that heavy steam and hot showers helped so I got some antibiotics and it did help. Now I am at the point where I can develop another infection quite easily if for example it gets too cold or too hot or I become to dehydrated or push my self too hard or my head gets too cold, even sometimes if cold air from the CPAP machine blows too long into my nose. I noticed that happened more often with a nasal mask. But I don't think the current headaches are from a sinus infection. Steam doesn't always help those.


Can you give us a rundown of what "everything" includes? In other words, have you tried any of the following? Did they make any difference at all---even if it was just for a little while? Do you still do any of the following on a regular basis?

Everything you wrote on the list I have tried. Currently I am only taking flounase and Sinus Buster which is the red pepper nose spray and really does work. The other nose sprays I can take for about a week or two and then they back fire and my nose is blocked no matter what and that leads to a guaranteed headache. I have the Nasal Crom and I am not sure I notice any difference. I don't think I notice much of a difference with the Flonase either. Claritin seems to dry my sinus and I felt it was causing more harm than good. Sudafed wires me up too much. Pain meds I would have to take daily and I avoid them because it doesn't seem like it is an answer to the problem. I do the saline nasal wash and I have two of the large sized plastic bulbs and that does help a lot at times but does nothing to prevent the headache once it starts. Over the years I have tried many things but there was nothing I noticed that made a dramatic difference.

The thing that happens is when I fall asleep without the CPAP mask, I feel a headache building up in as short a time as an hour. Even when I am in a chair. Years ago it would not be a headache but the heavy, dense, full, thick, dull, ache, sickly feeling head I would wake up with, now it is all that and a headache. I feel pretty good before I go to sleep, I actually feel great. But as soon as I wake up it can take hours to all day to feel normal again. I hate to go to sleep and sometime I fear sleeping because of how I will feel when I wake. It has to be sleep related this headache/head situation.

I can't tell you how much I appreciate everyone's help with this. I know that was a lot of reading you did if you made this far and I will try and edit things down in the future. I just wanted to make sure I included as much info as needed because I have lost so much of my life to health issues and I need to make some progress so I stand a chance of surviving. Things seem to get harder as I get older. I am fifty now.

I will make those changes and keep my eyes on the forum for feedback.

Thank you very much,
Russ

[robysue]

uriahsky,

It's late and I want to keep this short.

It does seem like you've been through the wringer with the sinus issues. Since you say that the sinuses usually respond positively to warm steam, you might try increasing the humidity all the way to its max setting of 5.

And since you're not needing to give the data to someone, you could also try pre-heating the humidifier by turning the machine on for a few minutes before you mask up.

Also make sure that you use a fine filter as well as the gray foam filter in the machine.

And if money weren't an issue a stand alone heated hose (like the Aussie hose) might help since your sinuses really don't like the cold air. As far as the Aussie hose goes, it is somewhat expensive, but it's also apparently much more durable than the standard unheated hoses that are supplied with the machine.

You also mention that you are taking Imitrex. Imitrex is a pretty potent migraine med that is supposed to be used at the onset of a migraine headache. It's supposed to be used only on an intermittent basis, but you write, "The only think I take at night is Imitrex because if I take it before I fall asleep I have a better chance of waking without a headache." How often are you taking the Imitrex at night?

Have you been officially diagnosed with severe episodic migraines? Or have you been diagnosed with chronic migraines? Migraine pain and sinus pain can be a bit difficult for some people to distinguish, but my understanding is that a doc is not going to write a prescription for Imitrex unless he is pretty certain that the headaches are migraines.

Since you have severe headache pain almost every day, I'm wondering if you've got chronic migraines as well as episodic ones. Yes, I know you can't see a doctor unless things are really bad, but I'm wondering if the doc who prescribed the Imitrex was aware that you've got severe headache pain on most days. I'm surprised that the doc didn't put you on a prophylactic migraine med. Of course those can have some pretty intense side affects: I could not tolerate topamax, lacmital, or depakote even though all three prevented my migraine headaches quite well. Eventually my neurologist's PA put me on a vitamin regime to help prevent the migraines.

So I'm wondering whether OTC migraine vitamins might do you some good. You can buy pre-mixed migraine vitamins. My PA originally recommended this formula from a Buffalo compounding pharmacy. Its ingredients are Riboflavin (vitamin B2), Magnesium, and Feverfew. But since I'm sensitive to ragweed and the warning label on Feverfew says to be careful if you are allergic to ragweeD, I opted to simply buy the Riboflavin and Magnesium separately and just take those in the same amount as the recommended tablets. The recommended daily doses are: 400 mg of Riboflavin and 400 mg of Magnesium, both split into two or three doses. So I take 200 mg of Riboflavin and 200 mg of Magnesium twice a day---once in the morning and once sometime in the evening or before I go to bed. I'm also on a megadose of a special prescription form of folate called Deplin due to a gene mutation that was discovered after the neuro's PA ordered a genetic test after I wiped out on the depakote at a pediatric dosage. I've been utterly amazed at how well the Riboflavin/Magnesium/Deplin(folate) combo has all but eliminated my chronic migraines. I also have a prescription for Maxalt, which is another medicine used to treat the pain of a migraine once it starts. Like Imitrex, the Maxalt is supposed to be taken as soon as the pain starts. In a typical month I may take two or three Maxalts at most---that's how well the vitamin combo is working for me as a migraine preventative.

So---if you know that migraines really are a problem for you, you might just want to try taking the Riboflavin and Magnesium for a while. Just note that since the Riboflavin/Magnesium combo is a prophylactic approach to treating the migraines, you have to be patient: It can take several weeks or even a few months before you notice much of a decrease in the frequency or severity of the migraines. But it's also ok to continue taking the Imitrex while taking the Riboflavin/Magnesium when a migraine does occur. So you don't need to suffer through a bad headache without the Imitrex.

[Pugsy]

"Can't tell if those Clear airways or the real deal or if they are showing up during periods of awakening due to the breathing."

I am not sure I follow along with this statement. Is it related to the one below?

"Do you spend a lot of time masked up and awake during the times that you see the large cluster of events?"

The lingo does take a bit and I tend to try to be brief so sometimes I expect you to read my mind. Typical woman huh?

I need to try to be brief as it is late and I am tired.

Centrals (clear airway events) are cessation of breathing so they are a form of apnea but the airway is open as opposed to obstructive apneas where the airway is fully closed (or almost) or hyponeas where the collapse may be around 50%.
"True" apneas in any large numbers warrant concern because we don't treat open airway cessation of breathing with pressure. The airway is already open so pressure doesn't help. For some people cpap pressures trigger central occurrence when there were no centrals prior to starting therapy. It is a complicated breathing response which I don't explain well.
A few true centrals are normal and everyone has them from time to time. Your report shows more than a few so we take notice. Now..here comes the real deal part. In a sleep lab there is more to the criteria for a central to be the kind that we worry about than just air flow. We need to be asleep first and foremost and thoracic effort needs to be measured.
These machines only have the air flow to measure. It doesn't know if you are asleep or not.

While awake we have rather erratic breathing and don't really notice it. The machine doesn't care, it just calls them like it sees them. It is normal to have some centrals at sleep onset, sleep stage transition and even simply turning over in bed because we often hold our breath and don't realize it. Hold your breath for 10 seconds...that is sort of a central because it is a cessation of breathing for 10 seconds but it is not the type of central that would be scored in a sleep lab setting because you are awake. Awake events of any kind are totally disregarded. The machine can be fooled and can record awake events because it doesn't know if we are asleep or not.

That is why the questions about being awake or not...trying to determine if we could explain away some of your centrals with the awake excuse. Trying to figure out if they are "real" centrals that would warrant concern or just awake artifacts that we can disregard.

If by chance your centrals are related to cpap pressure as the cause...then we see if we can reduce the pressure and thus maybe reduce the centrals but we still have to keep an eye on the obstructive events and the pressure that they need to be prevented. If you didn't have so many centrals (that we don't know for sure right now if they are a concern or not) we would just say increase the EPAP and see what happens but we want to be careful and not make more centrals happen IF they are related to the pressure itself. So we are cautious with any increases.

If someone does happen to have cpap induced centrals having auto machine with a wide range is not usually advised because we have to fine tune the pressures into a tighter range so as to hopefully reduce the obstructive events and at the same time hope to reduce the centrals. Hence the recommendation to increase only EPAP by a little to help address the obstructive events and limit the IPAP max in hopes that the centrals will reduce.

Some people spend a lot of time masked up with machine running and they are awake..tossing or turning or whatever and they get a lot of clusters of centrals show up on the reports. Those aren't "real" in the sense that they are cause for concern. When I see clusters of centrals like yours... my first thought (and hope) is that we can explain them away with the awake excuse. That is why I ask. I always hope for the easiest solution whenever possible.

What do we do if we can't explain them away? Well we do just what was suggested here. Assume that we need to see if we can get them reduced the traditional way which is a reduction in pressure on the top end and a little more pressure on the bottom end for the obstructives and hope that it helps. If it doesn't help and we determine that they are likely pressure related or they don't respond because you might have them even without cpap pressure then that warrants a different diagnosis and possibly a different machine. Let's not go looking for problems though and cross that bridge should we come to it. Right now we work with what we have in front of us and see if we can gain some improvement in your overall events.

I am tired and off to bed. Will await your report to see what happens with the changes you made tonight.
I see Robysue has responded as well. If you want to consider a heated hose...the Hybernite 2300 (cpap.com has it) works like the Aussie heated hose at about half the price. I have used one personally and it does help warm the air. I was getting ice cube nose last winter and I bought the Hybernite and I was totally satisfied with it.

[uriahsky]

It took me a while to get back here, I got busy but I also wanted to try the changes for a few days. So many times I felt I "figured it out" but only to find in a few days nothing really changed.

If Pugsy and Robysue are still out there I was hoping you could see if I am going in the right direction.

If you want you can skip most everything and maybe look at the charts from a few nights ago. That is when I changed the settings. And if you see that there might be some changes I should make let me know. Or explain what I should be looking for so I can learn and hopefully I won't become too much of a burden.

This missing data part happens because I wake up and I feel my sinus closing so I take the mask off and drink some water, sometimes I forget to put it back on and I fall asleep without the mask for an hour. I try not to let this happen.

There was an improvement. I didn't wake with a headache. So perhaps I am on the right track. I can't say it was an enjoyable night of sleep and I did wake up four or five times but I didn't feel the headache coming on and I felt much better when I woke up.

The details.

First to clear up a few things regarding the migraine/headaches.

After trying many things I found out that if I take a little bit of Imitrex either before I go to sleep or in the middle of the night and i use the CPAP I stand a much better chance of waking up without a headache.

I don't know who are the Doctors you see but the ones I see never really say anything definitive. The modus operandi of most doctors I see is to throw drugs at me and when I report back which ones don't work they try other ones. There was never any diagnosis of migraines. I can't really blame them because I can't afford the tests and that doesn't allow them to get an actuate diagnosis. The reason why I think this is all sleep related is because the headaches only happen in the morning when I wake up. I always feel great when I go to bed but when I wake up I feel awful and usually have a headache. It either takes hours or all day to feel somewhat normal.

I have tried the headache drugs that are suppose to be preventive but they didn't work. I will ask for Maxalt on the next trip and I went and purchased Calcium, magnesium, and a vitamen B complex and I am taking those.

Regarding the sinus problems

I do most everything suggested in the reply except I don't have a heated hose which I will look into. I warm the water, have a cover for the hose, keep the room warm, wear a thin shirt over my whole head to keep it warm when needed. I think it is just the air blowing that causes the sinus to close or I get dehydrated and they seems to close up from that.

Now I do understand more and maybe I was getting problems from the increase in pressure. Does it show in the graphs?

Thanks very much again, I really do appreciate all of the help.
Russ

[Pugsy]

What is your humidifier setting? Do I understand you that the air still seems cold and drying?

As you can see there was a small reduction in the obstructive component of your AHI (which are the obstructive apneas and hyponea) with the increase in EPAP pressure.
Obviously the clear airway events are still too high but it is really hard to evaluate them because I know some of them are awake events from restless sleeping which we would discount but that still leaves more than I would like to see until we can get you to where you can sleep through the night without the awakenings so we can maybe get an idea if those clear airway events are really a problem. In other words we can maybe explain a few away as sleep onset or sleep stage transition but I don't know if we can explain away this many. Need to have a full night of sleep without the sleep fragmentation to have any idea. I once saw a report where a guy had a clear airway index of 20 plus and once I got him to not lay in bed tossing and turning and fiddling with the mask for prolonged times...the clear airway index dropped to less than 1.0 so essentially pretty much we could explain away all his clear airway events as not being real in the sense that they stopped when he stopped giving the machine a chance to flag awake events.

Headaches are less?? but not gone and you are taking Imitrix at bedtime? Is that right?
There are still enough events present that we could blame the events themselves for causing oxygen level drops and associated headaches just from the oxygen level drops (if they are dropping).

The machine is wanting to raise the pressure...you can see that. The machine will NOT try to raise the pressure in response to clear airway events. It simply won't. It only responds to obstructive events and those event precursors.
So something obstructive is causing the machine to want to go higher.

We need to still get you sleeping better...better meaning minimal to none awakenings during the night so that we can better evaluate the clear airway event presence.
Your EPAP is still not quite high enough to do the best job on the obstructives. It is getting closer though.

I don't remember your humidifier setting...so please tell us what it is. Perhaps we can adjust it so that the air isn't so cold and drying and see if that helps with anything. I am hesitant to increase the IPAP max in view of the presence of the clear airway events but it is obvious that it is needed and perhaps the obstructive event presence is also maybe contributing to the fragmented sleep. So it is really hard to know which might be causing what.
So for now...I would increase EPAP to minimum 6.5 and increase maximum IPAP to 10.5 and still use the current pressure support setting. It is roaming a little but not much.

Right now the goal is to get you to sleeping more comfortably through the night so that we don't have the fragmented sleep that might be giving us some false clear airway events...false meaning either awake events or sleep onset/sleep stage change events. If you know that you spent half an hour trying to get to sleep...try to make a note of that fact so we can take that into account.

So let's see if we can adjust your humidifier to make you more comfortable...so what are you using now?
And another minor change in pressures to see if we can reduce the obstructive component.
And all the while we keep an eye on the clear airway events and try to get you so that we have a report without fragmented sleep...so we can better study those clear airway events.

[uriahsky]

My humidifier is set at 5 and it is almost too much at times. I don't think that is causing many problems currently.

At one time I was using the Nasal mask that blows air right into your nose and at first it was great but the constant cold air was killing me. I don't understand why they don't install a better heating system in these things.

I tried everything. I wrapped the hose in thick fabric. I kept the room warm. I put a heater right by the input of the CPAP. I even took apart a hair dryer and put it in the middle of the hose to the mask and put it on a variac to lower the amount of heat and it seemed to work but the smell of electric wires got to me. I found that the full face mask seemed to warm the air enough to make things OK. I also warm the water in the microwave before going to bed.

I have this sinking feeling that I am experiencing CSA.

I will make the changes you suggusted. But, if it is CSA are my only options a new $5000.00 machine?

In my attempts at trying to figure this all out I had purchased a Oxygen generator.
So I have that, I tried it once and I didn't feel very good using it. I know I am not supposed to just do things like this but I thought it was worth a try. It was $250.00 and didn't make any difference.

I also have a Pulse Oximeter. In case that helps with anything. I don't always wear it because it is uncomfortable to wear. But if you think it might add some useful info I can start to wear it again.

Have you heard of that Zeo Personal sleep manager? Would that help with understanding my situation?

I do take a small amount of Imitrex at night. Here is how I do that. If I feel in the night that I am starting to develop a headache I will take a little bit. Most of the headaches some during the last part of sleep. So if I wake up before this I will take maybe a quarter pill. If I take too much I will also feel awful from that.

Would trying straight Bilevel be something to try?

Thanks again, I am starting to learn about all of this and I also now understand more about CSA and OSA.

I will make those changes and hope for the best.

Thanks again,
Russ

[Pugsy]

Please use the overnight pulse ox for at least one night. Let's see what happens to your oxygen levels.
Do NOT use the oxygen concentrator at the same time. I want to see if the oxygen levels are dropping during the night all on their own.

I think you probably would benefit from a heated hose.
You could switch over to classic mode on the humidifier and get more heat BUT you also get a lot more chance for condensation. Plus I am not sure that even classic mode would give you the warmth you desire.
Cpap.com has the Hybernite 2300. I have used it myself and it does work. I was having some really bad "ice cube nose" with my PR S1 even with classic mode and a hose cozy last winter (I like a cold bedroom).
I think it would be a good investment for you. I sold mine recently because I bought a S9 machine and it came with a heated hose...or I would let you have mine.

Do you have complex sleep apnea or central sleep apnea? Well you for sure have obstructive sleep apnea but with all your other problems...the fragmented sleep...the headaches...the congestion..those all point to not sleeping very well and it is possible that if we can get you to sleeping better..get your obstructive apnea under control...you might get lucky and see a marked reduction in those centrals. You have so much other stuff going on that it is hard to really get much of an idea for sure what those centrals mean.

Right now my thoughts are sort of to set the centrals aside for just a little while...we won't ignore them but I thought that we need to work on getting your overall sleep architecture and quality and your obstructive sleep apnea...all under better control. It needs to be done anyway. So let's fix what we can fix...and see if we get lucky and maybe fix some of the central issue. Yes, straight bilevel is something that we could try though to be honest....I sort of pretty much made the machine straight bilevel with my recommended settings. EPAP min and IPAP max are very close and your pressure support only ranges from 2 to 4. I purposely limited the auto adjusting part so that we didn't have pressures flying around all over the place which might disturb sleep...and if those are real centrals caused by pressure..we really don't want the machine to have free reign on the obstructives.

So...let's work on the things that we know for sure need to be worked on. Let's see if we can get the obstructive events better controlled, let's see if your oxygen levels are dropping (that is important and I was going to ask you if you had a overnight pulse ox), let's see if we can get you some better quality of sleep with much less sleep fragmentation, let's see if we can help reduced discomfort with the humidifier issue...
All this we need to do anyway...then let's see if those centrals still want to hang around in large numbers.
Is that okay? No money for a sleep study which we know you need but I haven't found the money tree yet myself.
Let's work with what we know for sure needs work anyway...worry about ASV later if and when we have all the other issues sorted out and the centrals don't resolve once you have better sleep.
I really have seen worse reports (as far as centrals) than yours be totally resolved once fragmented sleep is resolved..can I promise you that yours will be? No, but there is a chance and you never know...you might get lucky.

Let's cross the ASV bridge...if we need to...and machines can be found for much less than $5 K...problem is self titrating the buggers...not nearly so easy as your current machine. Not impossible to self titrate but sure not easy.

I have family coming this weekend. I may not be on the forum quite as often and I might miss any updates if your thread gets moved off the front page between my visit. I will be checking private messages daily though.
Starting Friday...if you post something to your thread...could you please just send me a private message just telling me that you posted something so that I will know to go look. I don't want to make our exchange private because I think there is a lot for everyone to learn here and others may want to chime in. All I ask is that you let me know if you post...so I can go look at what you are reporting and respond. Otherwise I might miss what you say...and you think I am ignoring you which I would never do. So I will be sort of busy until after July 8....but I will at least check my private messages pretty much daily and if you have posted...I will go look at this thread and comment.

[Mikeb1369]

For EncoreAnywhere, does anyone have an idea on what the resolution is of the detailed breath by breath data (5hz, 1hz, 0.01 hz?).
How much data is captured. How often is it captured? One night every 7 days? Is it on the smartCard or is it wireless?
How long is that data stored? Forever? 1 year? 1 month?

Any answers to any one of these questions is most appreciated!!!!