Help

[Metter46]

Please look at the following Sleepy head reports and see if anyone can offer any reccomentadions to help my wife. She now has her Resmed S9 Auto with a straight cpap pressure of 11. The following graphs are from her second night using the Wisp nasal mask. The first night she had an AHI of 23.21 using nasal pillows, second night 19.26 using the wisp and last night as you can see from the posted graphs, was horrible. She had a ton of centrals and obstructives. Centrals were also an issue on the first two nights.

[Pugsy]

What were the pressure settings recommended after the titration study?

Did she sleep at all last night?

[Metter46]

What were the pressure settings recommended after the titration study?

Did she sleep at all last night?

Titration was for standard CPAP at a set pressure of 11 and no she slept very little.

[Pugsy]

Whew...It's actually a relief when you say she slept very little because that is one ugly report if someone said they slept.

Why the difficulty sleeping? Any idea?

When did she change to 11 cm cpap? These last 4 nights?

[Pugsy]

Forgot...these last 4 ugly nights...did she sleep much with them either?

[Metter46]

We did not change to a set pressure of 11 that is the prescribed pressure and where she started. She said that she slept okay the first two nights. These were the first nights on the new Resmed S9 autoset. To begin with I purchased an Intellipap for her to become used to sleeping with and had it set on auto 6-12. During these nights she ran an AHI of around 15 each night and it has been much worse on the fixed cpap pressure. There was no reporting on the Intellipap so I had no way of showing the events. Now with the reporting I agree that they all look awful.

Some nights she just has a very difficult time sleeping.

[SleepingUgly]

How well did she feel she slept the nights of these graphs?

[Metter46]

How well did she feel she slept the nights of these graphs?

Not well at all.

[Pugsy]

If she didn't sleep much at all...we can't trust the data.

I know one guy who had similar reports (well maybe not quite so ugly) but when questioned he admitted to sleeping little and spending hours laying there awake with mask and machine on and pretty much tossing and turning and restless.

So as an experiment.. he stopped just laying there and would get up and then go back to bed when sleep was more apt to happen and all the ugly went away. Every bit of his ugly was from the machine going whacko with awake breathing confusing it. You know it doesn't know if we are asleep or not...and awake breathing can be highly irregular when compared to asleep breathing and the machine can flag a ton of events while awake that aren't really happening.

Does she battle general insomnia fairly regularly or has been something else going on that makes it harder for her to get to sleep?

I assume there were no centrals of significance mentioned during the titration study? In this number a blind technician should/would likely have caught them.

Can you get me a screen shot of the first night with this machine where she says slept somewhat better?
AHI stuff on the left (the bar graph and pie chart stuff) and just the EVents graph and Flow rate graph on the right. Don't need all the others.

[Metter46]

If she didn't sleep much at all...we can't trust the data.

I know one guy who had similar reports (well maybe not quite so ugly) but when questioned he admitted to sleeping little and spending hours laying there awake with mask and machine on and pretty much tossing and turning and restless.

So as an experiment.. he stopped just laying there and would get up and then go back to bed when sleep was more apt to happen and all the ugly went away. Every bit of his ugly was from the machine going whacko with awake breathing confusing it. You know it doesn't know if we are asleep or not...and awake breathing can be highly irregular when compared to asleep breathing and the machine can flag a ton of events while awake that aren't really happening.

Does she battle general insomnia fairly regularly or has been something else going on that makes it harder for her to get to sleep?

I assume there were no centrals of significance mentioned during the titration study? In this number a blind technician should/would likely have caught them.

Can you get me a screen shot of the first night with this machine where she says slept somewhat better?
AHI stuff on the left (the bar graph and pie chart stuff) and just the EVents graph and Flow rate graph on the right. Don't need all the others.

This was the 2nd night on Cpap and she said she slept fairly good.



This was last night and she also said she slept pretty good.

[Pugsy]

I suspect that the clusters of CAs (centrals) are likely awake or semi awake times during the night and the other parts of the night where not much is going on is when she slept some.

Does she take any meds that might suppress respiration? Pain meds particularly?

Does she take any meds that might cause the general insomnia that she has?

I am thinking that the DME and/or doctor should probably be alerted to this situation. Even if the centrals are awake/semi awake centrals and not the other kind...her sleep architecture is extremely messed up...she isn't getting much if any good solid sleep.
That needs to be addressed even if the reports were nice and boring.
And I wouldn't be accepting "give it time" in this situation. I suspect that they were hoping the the sleep apnea was the primary cause of the insomnia and hoping by the machine fixing the OSA..it would fix the insomnia and I don't think the machine can work that much magic. CPAP machines don't fix "bad" sleep unless the bad sleeps only causative factor is OSA. I don't think OSA is the sole problem here.

Last night's OSA part of the report (Obstructive apneas and hyponeas) is well controlled but sleep architecture in general was still pretty bad.

Of course the OSA part of things we don't have much choice in "giving it time"....gotta use the machine anyway but I would be doing some serious hard looking at the insomnia part of things. I wouldn't be waiting 6 months and then deciding to look at insomnia.

Is there a follow up visit scheduled already to see how she is doing with the machine? If not..get one scheduled. Doesn't have to be tomorrow or anything like that but maybe a month...no more.. In the meantime take a hard look at anything that could be causing or making insomnia worse.

[Metter46]

I researched all of her medications and yes she does take some that would have an effect.
Tramadol for pain (insomnia and respiratory) - she will now try controlling with Tylenol.
Ditropan (insomnia) for over active bladder - will suggest to her primary care doc to change to detrol.
Zantac (insomnia) will change to Pepcid AC.

It will take a few days to get the Ditropan to Detrol prescription changed. However, the biggest culprit is most likely the Tramadol.

[zoocrewphoto]

Am I misunderstanding this? I see pressure as giving a minimum, median, 95%, and maximum. Shouldn't they all be at 11 if the machine was doing straight cpap of 11? Looks like the machine is set 4-11, unless I am not reading this correctly. I am not used to sleepyhead reports.

[Pugsy]

I have personal experience with tramadol. I can't take it after about 6 PM or I feel like I have mainlined a quart of coffee.
It also reduces sleep so that person is more "alert" an min races and all that stuff.
For nighttime pain...amitryptline in low dose of around 10 mg. It help low level pain and helps me sleep a little deeper so I don't get so many anwakenngs.

No experience with the others.

[Pugsy]

Am I misunderstanding this? I see pressure as giving a minimum, median, 95%, and maximum. Shouldn't they all be at 11 if the machine was doing straight cpap of 11? Looks like the machine is set 4-11, unless I am not reading this correctly. I am not used to sleepyhead reports.

Looks like ramp is being used for part of the time ...EPR s also use....so that is how come the averages are whacko.