Uncle Flappy's Journey

[Pugsy]

I think that the current 5 cm EPAP is most likely the bulk of your problems but with the sporadic sleep...it's really difficult to know with any certainty.
You need more continuous hours of sleep....if it is REM related then the pressure is not quite optimal and thus allowing some events to sneak past the defenses and when they do...bam you get woke up. Need to stop that cycle.

Your BiFlex setting shouldn't be affecting things so I wouldn't worry about it as long as you are comfortable with it.

I would be calling someone and getting someone to okay an increase in the EPAP ....if it were me and I was in your shoes in this situation.
I don't know how much because we simply don't have enough data to go on but 6 cm EPAP would be a good place to start.

[Uncle Flapp]

Thanks, Pugsy. You're the best.

- Flappy

[Uncle Flapp]

Well, I called the DME and spoke with my assigned RT. She was going to call the physician to see about getting the Rx changed. Since I have not heard back and won't tonight, I took it upon myself to change the EPAP pressure from 5 to 6. I'll run some reports in the morning.

- Flappy

[Uncle Flapp]

Here is the data from last night:



Still had a couple events wake me i.e. what appears to be an episode of CSR when first trying to sleep. I had not seen that before - could the CSR be a result of adding EPAP pressure?

[Pugsy]

First of all not all PB equals CSR.
Secondly, if something gets flagged while awake....it doesn't count.
PB is simply a waxing and waning of the air flow and CSR is just a type of Periodic breathing...there's more than one type of PB.

Increasing the EPAP such a tiny amount wouldn't cause CSR anyway...remember you are already using IPAP at a higher setting anyway.

[Uncle Flapp]

First of all not all PB equals CSR.
Secondly, if something gets flagged while awake....it doesn't count.
PB is simply a waxing and waning of the air flow and CSR is just a type of Periodic breathing...there's more than one type of PB...

Pugsy, to your point, I have been obessing over this. I do realize there is no easy fix and this is a process. My apologies for getting a little squirrely. On a more positive note, I had a relatively good night - made it past 4 hours in a single session for the first time on therapy. Probably would have made it longer but I woke with a very dry mouth due to an almost empty humidifier. I won't forget to top it off again. I do remember waking a couple of times in the night but resisted the temptation to take off the mask and fell right back asleep.

I'm quite pleased with this minor milestone as it is a step in the right direction. AHI was 12.5: OSA 5.0, HYP 1.46, and CA 6.04.



Oh - one more thing. I still haven't heard back from the doc on my request to bump the EPAP. Glad I did it on my own.

- Flappy

[Pugsy]

Don't go obsessing about clock watching but if you happen to be awake and alert enough during the middle of the night...try to remember to see if any of those events happen to correlate with awake times....especially those CAs.

Let's just concentrate on getter bigger blocks of sleep for right now....and not worry about changing anything else at the moment.

[Uncle Flapp]

Baby steps. Small progress. Still having problems falling asleep and staying asleep. It seems first onset of events, usually 30-45 minutes after lights-out, often wakes me. Last night, the 3rd time was a charm - I stayed asleep through the duration.



I also struggled with leaks last night. They weren't severe enough to impact therapy but cold air in the eye is never fun. Remzzzzs help but aren't a cure-all. Starting to question if the Quattro FX is right for me as a side sleeper.

- Flappy

[Uncle Flapp]

Day 10 since bringing home the new BPAP and I am starting to better adjust. Getting used to the pressure. In fact, I remember waking up once thinking I must have forgotten to turn on the machine. I placed my hand in front of the mask vent just to be sure. It was blowing air.
Still having poor numbers but at least most of the anxiety is gone and I am becoming more comfortable with the new routine.

I have a couple of questions that I am hoping y'all can answer:

• I am almost exclusively a side sleeper and when facing the inside of the bed, I am concerned about gale force winds bothering my wife. Are there any gadgets or tricks to keep vented air from being directed straight outward? She is grateful that I am treating my apnea and tells me the breeze is far better than my snoring but I am still concerned about bothering her.
• I started out on auto CPAP and my 90% was at 10cm. In switching to BPAP, the physician prescribed a setting of 10/5 which was based on the titration study; however, with so many OAs at home, the pressure must be too low. Is there a formula when moving from one type of machine to the other or are they different animals? In my ignorance, I would assume a baseline has been established and the EPAP would be set closer to 10.

I am grateful for this forum. Getting in touch with the sleep doctor is next to impossible and the DME RT is not nearly as knowledgeable as the folks here. Thank you for your help.

- Flappy

[Pugsy]

I started out on auto CPAP and my 90% was at 10cm. In switching to BPAP, the physician prescribed a setting of 10/5 which was based on the titration study; however, with so many OAs at home, the pressure must be too low. Is there a formula when moving from one type of machine to the other or are they different animals? In my ignorance, I would assume a baseline has been established and the EPAP would be set closer to 10.

There is no special official formula but normally EPAP seems to work best when set close to what the optimal minimum on APAP would have been...maybe not necessarily exactly (could be a little lower because of IPAP helping out).
I don't know why your EPAP was set to 5 when you seemed to need closer to 10 on APAP...it wouldn't have been the way I would thought they would go especially when using fixed bilevel pressures.... now if using auto adjusting bilevel pressures then maybe I would think about starting a bit lower and see where it wants to go.

For venting issues blowing on the spouse...not much you can do except face the other direction or maybe use a small decorative pillow to block the air flow when sleeping on your side.

[Uncle Flapp]

Wow - that was fast! Thanks for the prompt reply, Pugsy. On another note, centrals continue to be high so I will be setting up an appointment with a cardiologist just to rule out any problems with my ticker. Ignorance my be bliss but not in this case...

Hope you are well.

[Pugsy]

I am scratching my head over the centrals...if you are really asleep when they are popping up then maybe they are related to pressure and maybe IPAP should be reined in a bit.
Did you have many centrals when you were using APAP?
Maybe they are sleep onset centrals and if we can get you sleeping in longer blocks then the chance for sleep onset cycles will be reduced.

[Uncle Flapp]

Did you have many centrals when you were using APAP?

I was using an old M-series machine that I inherited from my father; therefore, the data did not specifically identify the centrals.

The sleep study doc hasn't returned my calls and the DME RT adds little value. I am open to ideas if you have any thoughts as to what should be tried next. I definitely want to bump the EPAP closer to 10 (maybe 8?). Not sure what to do with the IPAP as the hypopneas are averaging an index of 1.5. I suppose I can put the machine in CPAP mode and get some data if that would have value.

[Pugsy]

Scratching my head a little more...I don't know which way I would go if I were in your situation.
The centrals may not mean anything more than a bunch of sleep onsets...or they may be more of a concern.
If you were telling me you were sleeping well with minimal to none awakenings during the night then we would of course watch them a little closer.

You know the M series machines would/could sense centrals but they just would dump them in either the OA or hyponea basket.
So if your AHI was acceptable with the M series machine there's a real good chance that centrals weren't an issue.
I think I would tend to think that these centrals were either awake/semi awake breathing irregularities or sleep onset centrals if the AHI on the M series was acceptable.

How about just going back to basics and see what happens? Try cpap mode at maybe 8 or 9 cm just to see what happens.
There's a very small number of people who seem to develop centrals with bilevel pressures (extremely rare) so using cpap mode would eliminate that remote chance.

I still think that whatever gets done that getting much larger blocks of sleep is going to be real important when evaluation therapy. With highly fractured sleep we just don't know if what we are seeing is related to sleep apnea or to simply awake/semi awake breathing junk getting flagged by mistake.

[Uncle Flapp]

I appreciate your insight and will switch the machine to CPAP 8cm.
There is no question that I will meet the out of pocket deducible on my insurance so I'm going to see a cardiologist regardless of what our little experiments show. I'm 48, a non-smoker, heavy but not obese, and feel great so the likelihood of a heart problem is small but worth ruling out if for no other reason that I have young kids that need their dad.

My duration of sleep is improving although still not ideal. Last night I did 5 consecutive hours. Do we need 8 or so for better data?